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This is VAERS ID 295526

Case Details

VAERS ID: 295526 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: California  
Vaccinated:2007-10-19
Onset:2007-10-27
   Days after vaccination:8
Submitted: 2007-11-05
   Days after onset:9
Entered: 2007-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / UNK LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2208AA / 1 LA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 6 LA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0127U / 2 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Ataxia, Convulsion, Headache
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS: CT scan WNL. MRI initially WNL. Repeat MRI revealed focal lesion in corpus callosum. MRA of neck WNL. CSF protein 118 (H), WBC 54 (H), RBC 2 (H), lymphs 92% (H), monos 8% (L). HSCRP 2.05 (H)Blood, urine & CSF cultures neg. Trach aspirate culture (+) staph aureus (not MRSA).
CDC Split Type:

Write-up: approximately 2 weeks after vaccine administration developed headache, ataxia, and seizures requiring antiepileptics, steroids, antibiotics. 11/6/07 Received vax records & pcp medical records. VAERS database updated w/same & date of vax corrected to 10/19/2007. Flu shot not on vax record but ordered on pcp note. Pcp note of 10/19 indicates patient in good health on day of vax. Returned to pcp 11/2/07 w/dizziness, fever, HA, slight cough. Dx w/viral infection. T/C to provider to clarify vax info. Received 2nd page of vax record w/flu vax info. VAERS database updated w/same. 11/30/07 Reviewed hospital medical records which reveal patient experienced HA, vomiting, ataxia & right sided spasticity. Had HA x 7 days prior to admitl w/increasing ataxia x 3 days. Admitted 11/2-11/10/2007. As preparing for LP, patient had seizure & desaturation. Intubated & admitted to PICU. Neuro consult done. Given IV antibiotics & antivirals until cultures came back neg. Extubated 11/5 & progressed well on antiseizure meds. FINAL DX: Encephalitis; ataxia; headache.


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