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This is VAERS ID 274635

Case Details

VAERS ID: 274635 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-03-22
Onset:2007-03-22
   Days after vaccination:0
Submitted: 2007-03-23
   Days after onset:1
Entered: 2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Blood pressure, Chills, Confusional state, Dizziness, Muscle contracture, Oxygen supplementation, Pallor, Paraesthesia, Paraesthesia oral, Posture abnormal, Sensation of heaviness, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (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? No
Previous Vaccinations: NONE per parent~ ()~NULL~~In Patient|NONE per parent~ ()~NULL~~In Sibling1|NONE per parent~ ()~NULL~~In Sibling2
Other Medications: None
Current Illness: No
Preexisting Conditions: None noted on vaccine history form completed by mother before immunizations given
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adacel given first, appeared fine. HPV then given and within a minute or two, client''s chin fell to chest while arm contracted at elbow up off lap. She did not respond to name or shaking of shoulders for approximately one minute (B/P 100/60, pulse 64). Then became aroused, although very confused and unsure where she was. Called out for her mom and asked where she was and said she felt dizzy. Client then assisted off chair to floor. Became extremely pale, c/o lips tingling, B/P 130/64 at 1800. While resting c/o "heavy head" feeling and paresthia in R arm, R and L hands and feet as well as c/o of chills. At 1805 EMS called and responded by 1810 (B/P 130/66, RR 18 at 1805). Given oxygen per EMS. Client transported to ER. Client discharged from ER within a couple hours. Parent contacted at 2000 and states client was "fine now". Returned to school on 3/23/07 per mother.


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