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This is VAERS ID 275712

Case Details

VAERS ID: 275712 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-04-03
Onset:2007-04-03
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:3
Entered: 2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U226AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram abnormal, Fall, Head injury, Headache, Neck pain, Subarachnoid haemorrhage, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Allergic to penicillin ALLERGIES: PCN, urticaria. PMH: fainting episodes, mild concussion 3-5 mos ago from sports injury. Pounding headaches 1-3 x/week. Family hx of headaches.
Allergies:
Diagnostic Lab Data: LABS: CT at transfer hospital revealed hemorrhagic focus within medial left frontal high convexity adjacent to falx w/subdural hematoma along the falx. WBC 19.8. CT angiography was WNL. EEG was reported as neg but no report provided.
CDC Split Type:

Write-up: Fainted within 10 min of receiving vaccines and fell backward and hit head on carpeted floor was unresponsive for 20-30 seconds. Complained of headache and neck pain. Transported to ER - CT showed traumatic subarachnoid hemorrhage. Transferred to PICU. 5/11/07 Received medical records from hospital which reveal patient experienced syncopal episode & fell backward w/o bracing herself, striking posterior head & becoming dazed & minimally responsive for several minutes. Seen at outlying hospital & had CT scan which revealed SAH & skull fx. Exam revealed alert & oriented, hematomas over skull. Tx w/dilantin. Neurosurg & neurology consults done. Seizure was ruled out & dilantin d/c. Strong suspicion for vascular abnormality due to amount of intracranial bleeding after fall. FINAL DX: traumatic subarachnoid hematoma.


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