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This is VAERS ID 274290

Case Details

VAERS ID: 274290 (history)  
Age: 16.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-01-16
Onset:2007-01-16
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:56
Entered: 2007-03-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB143BA / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / 0 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Dyskinesia, Fall, Hyperhidrosis, Pain in extremity, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0702USA03295

Write-up: Information has been received from a licensed practical nurse concerning a 16 year old female student with no pertinent medical history who on 16-Jan-2007, at 14:45, was vaccinated, into the left deltoid, with a first dose of Gardasil (lot #655619/1427F) concomitantly with a first dose of Havrix (lot AHAVB143BA) in the left arm and a first dose of Menactra (lot U1968AA) into the right deltoid. On 16-Jan-2007, at 14:45, while sittings on table, the patient complained of severe pain in the left arm. As the patient was complaining, she fell forward, and the licensed practical nurse laid her down. The patient''s eyes were fixed staring at the ceiling and her body started jerking wildly and thrashing. The patient went from jerking and trashing to "jumping up and asking what happened." The patient was guided back to the table and her body started jerking and thrashing with her eyes fixed on the ceiling and non-reactive. Subsequently, the patient came to diaphoretic. In January 2007, the patient recovered. No further information is available.


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