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This is VAERS ID 288762

Case Details

VAERS ID: 288762 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Iowa  
Vaccinated:2007-08-06
Onset:2007-08-06
   Days after vaccination:0
Submitted: 2007-08-22
   Days after onset:16
Entered: 2007-08-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination
SMQs:, Accidents and injuries (narrow), Medication errors (narrow)

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:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC Split Type: WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


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