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This is VAERS ID 281563

Case Details

VAERS ID: 281563 (history)  
Age: 17.0  
Gender: Female  
Location: Georgia  
Vaccinated:2007-06-12
Onset:2007-06-12
   Days after vaccination:0
Submitted: 2007-06-13
   Days after onset:1
Entered: 2007-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB149AA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2137AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2572AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0334U / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Dyskinesia, Malaise, Muscle twitching, Pallor, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none reported~ ()~NULL~~In Patient|none reported~ ()~NULL~~In Sibling1
Other Medications:
Current Illness: NONE
Preexisting Conditions: After incident parent reported previous history of seizures.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came into clinic with parent for vaccines, Tdap,Hepatitis A,Menactra, gardasil,varivax. After vaccines pt skin tone became white and she said "I don''t feel well" then pt had syncopal episode nurse used ammonia inhalant to bring pt around pt legs elevated ice applied to back of neck, pt initialy responded to nurse and parent, then pt had what appeared to be another syncopal episode but pts body began twitching and jerking and then pt lost control of her bladder, another ammonia inhalant was used to bring pt around. When pt was able she was assisted to exam table and placed in supine position with legs elevated. After incident nurse questioned parent if pt had history of seizures and parent confirmed previous history although on immunization consent form questionairre parent anwered no to question of history of seizures or neurological problems. pt given 8 ozs apple juice which she tolerated well and left clinic approximately 30 minutes later with parent. Parent instructed to follow up with MD.


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