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This is VAERS ID 288215

Case Details

VAERS ID: 288215 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2007-07-13
Onset:2007-07-13
   Days after vaccination:0
Submitted: 2007-08-10
   Days after onset:28
Entered: 2007-08-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood test normal, Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Tonic clonic movements
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC Split Type:

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


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