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This is VAERS ID 348870

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 348870 (history)  
Form: Version .0  
Age: 17.0  
Sex: Female  
Location: Texas  
   Days after vaccination:2
Submitted: 2009-06-10
   Days after onset:48
Entered: 2009-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Asthenia, Blood potassium decreased, Dizziness, Fall, Mean cell haemoglobin increased, Protein urine present, Rash, Rash pruritic, Syncope, Urine abnormality, Urine analysis abnormal, Urticaria, Visual impairment, pH urine increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: 7/24/09 ER records received DOS 6/3/09 and 6/22/09. Chicken pox. Bulemia, depression.
Diagnostic Lab Data: Immunocap. 7/24/09 ER records received DOS 6/3/09 and 6/22/09. LABS and DIAGNOSTICS: CHEM - Postassium 2.7 mmol/L (L). CBC - MCH 31.5 PG (H). Urinalysis - pH 9.0 (H), Protein trace, Bacteria 3+, Mucous trace, Amorph Phos 2+.
CDC Split Type:

Write-up: Rash beginning on bilateral arms. On and off x 1 wk. Rash down bilateral legs and cont. on arms x 3-4 days. Began with rash to face and neck 6-8-09 comes and goes. Rash seized yesterday began again today. 7/24/09 ER records received DOS 6/3/09 and 6/22/09. Assessment: Hives/Urticaria. Hypokalemia, bulemia. Patient presents on 6/3/09 with an itchy urticarial rash on arms, legs and trunk, of one month duration. On 6/22/09 c/o syncope X2, feels weak, falling. Lightheadedness, trouble with vision. Collapsed.

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