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This is VAERS ID 275712

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

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

Administered by: Private      Purchased by: Unknown
Symptoms: Computerised tomogram abnormal, Electroencephalogram normal, Fall, Head injury, Angiogram cerebral

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Allergic to penicillin
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


Changed on 12/8/2009

VAERS ID: 275712 Before After
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U226AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Computerised tomogram abnormal, Electroencephalogram normal, Fall, Head injury, Headache, Neck pain, Subarachnoid haemorrhage, Subdural haematoma, Syncope, Unresponsive to stimuli, White blood cell count increased, Angiogram cerebral, Scan brain

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No No
ER or Doctor Visit? Yes
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.
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 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.


Changed on 4/7/2010

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

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Electroencephalogram normal, Fall, Head injury, Headache, Neck pain, Subarachnoid haemorrhage, Subdural haematoma, Syncope, Unresponsive to stimuli, White blood cell count increased, Angiogram cerebral, Scan brain

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
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.
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.


Changed on 2/14/2017

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

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Electroencephalogram normal, Fall, Head injury, Headache, Neck pain, Subarachnoid haemorrhage, Subdural haematoma, Syncope, Unresponsive to stimuli, White blood cell count increased, Angiogram cerebral, Scan brain

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
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.
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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