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This is VAERS ID 277309

Case Details

VAERS ID: 277309 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-04-11
Onset:2007-04-11
   Days after vaccination:0
Submitted: 2007-04-12
   Days after onset:1
Entered: 2007-04-24
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB148AA / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1908AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148F / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Hypotonia, Loss of consciousness, Muscle rigidity, Oxygen saturation normal, Pallor, Postictal state, Staring
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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: O2 Sat 98%, BP 102/78
CDC Split Type:

Write-up: After vaccine was given pt stated "she felt like she was going to pass out" she turned pale and rigid and lost conscious for about 1 min and when she came to she had post ictal s/s of a blank stare for about 5-10 sec and no response. Pt did walk back to a room without much time, when she got back to the room she became "limp" and needed to be lifted onto a tablet. Went home A+o x ''53


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