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This is VAERS ID 295526

Case Details

VAERS ID: 295526 (history)  
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 / - LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2208AA / 0 LA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 5 LA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0127U / 1 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
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
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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