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This is VAERS ID 276351

Case Details

VAERS ID: 276351 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2007-04-11
Onset:2007-04-11
   Days after vaccination:0
Submitted: 2007-04-16
   Days after onset:5
Entered: 2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2221AA / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Blood pressure normal, Fall, Head injury, Heart rate, Neurological examination normal, Posturing, Staring
SMQs:, Dystonia (broad), Psychosis and psychotic disorders (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Vital signs stable, neurologicallly stable, per provider note
CDC Split Type: NH0716

Write-up: Sitting on exam table , received vaccines Gardasil and Menactra. Got down from exam table, stood up and fell forward, hitting forehead on the wall. Nurse pivoted her onto a chair, sitting position. "Patient''s eyes were open, back arched, arms straight and posturing" x approximately 3 seconds. Relaxed - still staring, not alert. Nurse and medical student placed her on exam table reclining.


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