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This is VAERS ID 637234

Case Details

VAERS ID: 637234 (history)  
Age: 11.0  
Gender: Female  
Location: Georgia  
Vaccinated:2015-10-16
Onset:2015-11-01
   Days after vaccination:16
Submitted: 2016-05-26
   Days after onset:207
Entered: 2016-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FJ2099 / 2 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L013429 / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M15031 / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS H5299 / 0 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Abasia, Activities of daily living impaired, Arthralgia, Contusion, Diarrhoea, Dyspnoea, Fatigue, Hypersomnia, Loss of consciousness, Seizure, Throat tightness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illnesses at time of vaccine
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throat closing could not breath, passing out, seizures, vomiting, diarrhea, unexplained bruising, extreme fatigue resulting in sleep for 12 hours plus. Severe joint pain, sometimes can''t even walk. Can''t attend school or play sports anymore.


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