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This is VAERS ID 271123

Case Details

VAERS ID: 271123 (history)  
Age: 11.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-11-01
Onset:2006-11-17
   Days after vaccination:16
Submitted: 2007-04-06
   Days after onset:139
Entered: 2007-01-22
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR AC52B007AA / 0 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood glucose, Dizziness, Laboratory test, Ophthalmological examination, Ophthalmological examination abnormal, Panophthalmitis, Urine analysis
SMQs:, Anticholinergic syndrome (broad), Optic nerve disorders (broad), Corneal disorders (broad), Vestibular disorders (broad), Ocular infections (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Lyme disease, Ear infection, Reactive airway disease None
Diagnostic Lab Data: diagnostic urinalysis ophthalmogical exam blood glucose blood glucose, 12/08/08, 120; urine bilirubin test, 12/08/06, 1+, negative, abnormal; urine leukocyte esterase, 12/08/06, 1+, negative, abnormal; urine protein, 12/08/06, trace, negative, abnormal; urine urobilinogen, 12/08/06, 1+, negative, abnormal
CDC Split Type: WAES0612USA02786

Write-up: Information has been received from a nurse practitioner concerning an 11 year old female with a history of Lyme disease, and ear infection, "reactive airways" and no known allergies or adverse drug reactions reported. On 01-Nov-2006, the patient was vaccinated intramuscularly with 0.5 ml of Gardasil vaccine (yeast). Subsequently, the patient developed dizziness for about three weeks. It was reported that the patient "had some lab studies done and was referred to a neurologist (she had not seen him yet). The laboratory diagnostics included blood sugar, a urinalysis and vision screening (results not reported). The nurse practitioner reported that there were some family issues that were occurring also be a cause. The patient was referred to an eye physician because she failed her school eye exam. At the time of this report, the patient was recovering from the events. Additional information has been requested. This is in follow-up to report (s) previously submitted on 1/16/2007. Initial and follow-up information has been received from a nurse practitioner concerning an 11 year old female student with a history of lyme disease, and ear infection, "reactive airways" and no known allergies or adverse drug reactions reported. On 01-NOV-2006, at approximately 16:30, the patient was vaccinated intramuscularly, into the right arm, with 0.5 mL first dose of GARDASIL (lot #653938/0954F) concomitantly with an intramuscular first dose of TRIPEDIA (lot #AC52B007AA) into the left arm and an intramuscular first dose of MENECTRA (lot # U2157BA) into the left arm. On approximately 17-NOV-2006 the patient developed dizziness. The patient was seen in the doctors office on 08-DEC-2006. It was reported that the patient "had some lab studies done and was referred to a neurologist (she had not seen him yet)". The laboratory diagnostics included blood sugar (105 on 08-DEC-2006), a urinalysis and vision screening. The results of vision screening test not reported. The nurse practitioner reported that there were some family issues that were occuring that could also be a cause. The patient was referred to an eye physician because she failed her school eye exam. At the time of this report, the patient was recovering from the events. No further information is available. This is in follow-up to report(s) previously submitted on 1/16/2007. Initial and follow up information has been received from a Nurse Practitioner concerning an 11 year old female student with no medical history who on 01-NOV-2006 at approximately 5:00 p.m. was vaccinated IM in right arm with her first dose of GARDASIL, lot #653938/0954F. Subsequently, the patient experienced prolonged dizziness. The patient was seen in the office on 08-DEC-2006 complaining of dizziness, she was unsure of the onset date but it was after the injection. Her blood glucose (non-fasting) was 120 (see laboratory data section for abnormal urinalysis results). She was referred to a neurologist. Per follow up one week later, the patient was doing better. The Nurse Practitioner reported that she was unsure if the 2nd dose of GARDASIL should be administered. Additional information is not expected.


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