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This is VAERS ID 267795

Case Details

VAERS ID: 267795 (history)  
Age: 14.0  
Gender: Female  
Location: California  
Vaccinated:2006-11-09
Onset:2006-11-09
   Days after vaccination:0
Submitted: 2006-11-22
   Days after onset:13
Entered: 2006-11-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / - RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2119AA / - GM / -

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Anger, Crying, Depression, Pain, Suicide attempt
SMQs:, Suicide/self-injury (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200603096

Write-up: Seriousness criteria other medically significant (OMIC). Initial report received from the pts mother via a health care professional, on 11/14/06. A 14 year old female pt, received on 11/9/06, Menactra (lot number U2119AA), into the right deltoid (dose and route of administration not reported). The pt received on the same day (11/9/06) Gardasil (lot number 0688F) into the left deltoid, as concomitant vaccination (dose and route of administration not reported). The pt had no history of depression. At the eve of vaccination, 11/9/06, the pt had arm soreness (the reporter was unsure which arm). The pt also became very depressed, frustrated, angered, crying and attempted to cut her wrists with scissors. The wrist site described as scratch by the reporter. At the time of this report, 11/14/06, there had been no ER or medical doctor MD visits for the pt and the pts outcome was unk. No corrective treatment was reported.


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