National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 276351

Case Details

VAERS ID: 276351 (history)  
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 / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2221AA / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
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.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=276351


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166