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This is VAERS ID 675713

Case Details

VAERS ID: 675713 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-08-24
Onset:2012-10-18
   Days after vaccination:55
Submitted: 2016-12-29
   Days after onset:1533
Entered: 2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H011350 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4347AA / 2 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Arthropathy, Autonomic nervous system imbalance, Complex regional pain syndrome, Dystonia, Fatigue, Fibromyalgia, Hypermobility syndrome, Migraine, Myofascial pain syndrome, Orthostatic hypotension, Syncope, Tension headache
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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, 24 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to morphine and bilateral hearing loss
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Complex Regional Pain Syndrome, Joint Hypermobility Syndrome, Orthostatic Hypotension, Dystonia, Dysautonomia, Tension Headaches, Migraines, Myofascial Pain Syndrome, Fibromyalgia, SI Joint Dysfunction, fatigue, Vasovagal Syncope.


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