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This is VAERS ID 279017

Case Details

VAERS ID: 279017 (history)  
Age: 16.0  
Gender: Female  
Location: Washington  
Vaccinated:2007-05-16
Onset:2007-05-16
   Days after vaccination:0
Submitted: 2007-05-18
   Days after onset:2
Entered: 2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0246U / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2223AA / 0 GM / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B015BA / 0 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Grand mal convulsion, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: pt. complained of dizziness for last 5 days
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few seconds after the vaccines were administered the pt. passed out and then had tonic clonic seizure lasting approx. 1 minute.


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