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This is VAERS ID 662875

Case Details

VAERS ID: 662875 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-01-22
Onset:2007-01-22
   Days after vaccination:0
Submitted: 2016-10-31
   Days after onset:3569
Entered: 2016-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U22206A / UNK RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB143BA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922AB / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B01HH / UNK RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood test, Dizziness, Hypoaesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Steroid inhaler; NEXIUM; IMITREX; ZOFRAN
Current Illness: yes, we were in for a sick visit.
Preexisting Conditions: Acid Reflux, Hiatal Hernia, migraines
Allergies:
Diagnostic Lab Data: At this time Blood tests, and multiple dr''s. visits and communications with dr. and ER visits.
CDC Split Type:

Write-up: Dizziness, vomiting, numbness of extremities.


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