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This is VAERS ID 411924

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 411924 (history)  
Form: Version 1.0  
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3566AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1778Y / 2 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Amnesia, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), 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? 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=20180914&IDNUMBER=411924


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