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This is VAERS ID 411924

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 411924 (history)  
Form: Version .0  
Age: 17.0  
Sex: 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.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=411924


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