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This is VAERS ID 411387

Case Details

VAERS ID: 411387 (history)  
Age: 15.0  
Gender: Male  
Location: California  
Vaccinated:2010-12-02
Onset:2010-12-02
   Days after vaccination:0
Submitted: 2010-12-03
   Days after onset:1
Entered: 2010-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3732AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0992Z / 0 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Fall, Head injury, Tonic clonic movements
SMQs:, Convulsions (narrow), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The child started having tonic clonic type movements, then fell and hit his head and continued with tonic clonic type movements. We activated EMS and child was taken to ED via ambulance.


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