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This is VAERS ID 283845

Case Details

VAERS ID: 283845 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-06-27
Onset:2007-06-27
   Days after vaccination:0
Submitted: 2007-06-29
   Days after onset:2
Entered: 2007-07-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0442U / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524C / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2734AA / 6 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Clonus, Dizziness, Electrocardiogram normal, Full blood count, Head injury, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Albuterol
Current Illness:
Preexisting Conditions: Stable exercise induced asthma, Allergic garamycin
Allergies:
Diagnostic Lab Data: CBC WNL, EKG WNL, D-Dimer <.22 WNL
CDC Split Type:

Write-up: Within a couple minutes of admin, she verbalized she felt faint, slumped and hit head against exam table mirror, became pale, clonic arm movements x 4 per mom. Administered O2, elevated feet gave water, pretzels. Hypotensive in ER where she was sent with 1 hour in office.


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