| VAERS ID: |
411924 (history) |
| Form: |
Version .0 |
| Age: |
17.0 |
| Gender: |
Female |
| Location: |
New Mexico |
| Vaccinated: | 2010-11-29 |
| Onset: | 2010-11-29 |
| Days after vaccination: | 0 |
| Submitted: |
2010-11-29 |
| Days after onset: | 0 |
| Entered: |
2010-12-07 |
| Days after submission: | 8 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR |
U3566AA / 0 |
LA / IM |
| HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
1778Y / 1 |
RA / IM |
Administered by: Public Purchased by: Unknown
Symptoms: Acute sinusitis,
Adverse drug reaction,
Amnesia,
Bacterial test,
Blood sodium decreased,
Convulsion,
Headache,
Immediate post-injection reaction,
Mean platelet volume increased,
Nasal congestion,
Nausea,
Oropharyngeal pain,
Red blood cells urine positive,
Tremor,
White blood cell count decreased,
White blood cells urine positive
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Oropharyngeal lesions, non-neoplastic, non-infectious and non-allergic (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sinusitis/upper respiratory infection
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Nurse giving injection, patient and mom were present when apparent seizure took place. I was called stat to room where pt was sitting in a chair. Apparently patient was sitting on exam table when the HPV (2nd inj) was given and she began her seizure activity. She is amnestic of event. |
