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This is VAERS ID 485513

Case Details

VAERS ID: 485513 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2011-10-03
Onset:2011-11-06
   Days after vaccination:34
Submitted: 2013-02-05
   Days after onset:457
Entered: 2013-02-25
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / UNK UN / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M10126A / UNK UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3518AA / UNK UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Amnesia, Convulsion, Epilepsy, Fear, Personality change
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Epilepsy as a result of vaccination
CDC Split Type:

Write-up: Seizures started 2 weeks after the shot. Personality changed. Patient felt scared. Loss of memory. Taking zonisamide 6 pills a day to control seizures.


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