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This is VAERS ID 270532

Case Details

VAERS ID: 270532 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Florida  
   Days after vaccination:0
Submitted: 2007-01-12
   Days after onset:9
Entered: 2007-01-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Blindness transient, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC Split Type: WAES0701USA00620

Write-up: Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of GARDASIL. Concomitant therapy included Concerta. Later that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency room. At 10:03 am, the patient had a second incidence of headache and temporal blindness that also lasted approximately 40 seconds. At the time of this reported, the patient was stable but was to be admitted to the hospital for observation. At the time of this report, the outcome was unknown. Additional information has been requested. 01/22/07-records received and reviewed from Medical Center for DOS 01/0407-transferred with DX of new onset seizures to another Hospital. Records requested. CT brain without contrast: negative exam, recommend MRI. 01/30/07-rcords received for DOS 01/04-01/05/07 DC DX: 1. Vasovagal response secondary to dehydration 2. Syncope secondary to #1. Hospital Course: Transferred from Med Ctr. Admitted with vomiting decreased oral intake since yesterday, complained of blindness and severe headaches this morning with fever of 101.4. Experienced 35-45 second of complaining of blindness, loss of consciousness and staring episode at Med Ctr. PMH: Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.

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