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This is VAERS ID 348870

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 348870 (history)  
Form: Version 1.0  
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: Bacterial test, Blood test abnormal, Fall, Full blood count, Hypokalaemia, Mean cell haemoglobin, Rash, Syncope, Urine phosphate decreased, Urticaria, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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+. Last time patient seen in office was 1 yr ago (6/2009) numbers that we have for contact are no longer current. Can''t get ahold of patient to know if patient has recovered.
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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