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This is VAERS ID 277122

Case Details

VAERS ID: 277122 (history)  
Age: 17.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-04-10
Onset:2007-04-10
   Days after vaccination:0
Submitted: 2007-04-12
   Days after onset:2
Entered: 2007-04-20
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Dizziness, Fall, Head injury, Headache, Nausea, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C6-C7 likely related to positioning or muscle spasm. X-ray Skull-no abnormality. X-ray thoracic and lumbar spine-shows narrowing of L1 vertebral body, probably old injury.
CDC Split Type:

Write-up: 940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


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