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This is VAERS ID 485513

History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2013

VAERS ID: 485513
Age:11.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-03
Onset:0000-00-00
Submitted:2013-02-05
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / - UN / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Amnesia, Convulsion, Epilepsy, Fear, Personality change

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
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.


Changed on 4/13/2013

VAERS ID: 485513 Before After
Age:11.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-03
Onset:0000-00-00 2011-11-06
Submitted:2013-02-05
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / - UN / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - M10126A / - UN / UN
TDAP: TDAP (NO BRAND NAME) TDAP (ADACEL) / UNKNOWN MANUFACTURER SANOFI PASTEUR - C3518AA / - UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Amnesia, Convulsion, Epilepsy, Fear, Personality change

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
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.


Changed on 9/17/2013

VAERS ID: 485513 Before After
Age:11.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-03
Onset:2011-11-06
Submitted:2013-02-05
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / - UN / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M10126A / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3518AA / - UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Amnesia, Aspartate aminotransferase increased, Auricular swelling, Confusional state, Convulsion, Dysarthria, Ear pain, Electroencephalogram abnormal, Epilepsy, Fatigue, Fear, Gait disturbance, Grand mal convulsion, Hallucination, visual, Lymphocyte count increased, Mean cell haemoglobin concentration increased, Mean cell volume decreased, Monocyte count increased, Mouth ulceration, Neutrophil count increased, Personality change, Rhonchi, Tonsillar hypertrophy, Tremor, Unresponsive to stimuli, Upper respiratory tract infection, White blood cell count increased, Postictal state, Cerumen impaction, Platelet count increased, Lymphocyte percentage increased, Abnormal behaviour, Adverse drug reaction, Foaming at mouth, Oropharyngeal pain, Granulocyte percentage

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None The following information was obtained through follow-up and/or provided by the government. 04/26/12 PMH: Dust allergy.
Diagnostic Lab Data: Epilepsy as a result of vaccination The following information was obtained through follow-up and/or provided by the government. 04/10/13 Labs and Diagnostics: CHEM - AST 42 U/L (H). CBC - MCV 79.4 fl (L) MCHC 33.4 g/dl (H) Gran 43.4% (L) Lymph 45.6% (H) Lymph# 6.0 (H) Mono# 0.9 (H). 04/26/13 Labs and Diagnostics: EEG - Abnormal. CBC - WBC 11.1 x10E3/uL (H) Platelets 376 x10E3/ul (H) Neut 6.3 x10E3/ul (H) Lymph 3.6 x10E3/ul (H) Mono 0.9 x10E3/ul (H).
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. The following information was obtained through follow-up and/or provided by the government. 03/27/13 PCP medical records received. Service dates 10/03/11 to 01/10/13. Diagnosis: Seizure disorder. Patient presents for periodic PCP visits for upper respiratory infections, sore throat, enlarged tonsils, mouth ulcer, rhonchi, wheezes, cerumen in ears, ear swelling, ear ache, fatigue syndrome. 04/10/13 ER records recieved. Service date 11/06/11. Diagnosis: Seizure disorder (convulsive). Child presents for evaluation of grand-mal seizure, 1-5 minutes, single episode. In post-ictal state. 04/26/13 Hospital records, consultations and discharge summary received. Service dates 11/06/11 to 11/07/11, 03/06/12 to 03/08/12. Diagnosis: Generalized Epilepsy. Patient was found unresponsive, frothy secretion from mouth, trembling by parent. Later awake but confused, slurred speech, could not walk on his own. Admitted for generalized tonic-clonic seizure. Rx for Keppra and Diastat, discharged. At a later date was admitted for video EEG monitoring due to visual hallucinations, possible seizures, and behavioral side effects from Keppra XR. Medications adjusted, discharged. 04/26/13 Consultation records received. Service dates 12/01/11 to 12/27/12. Additional information abstracted. Diagnosis: Epilepsy generalized. Patient present for seizure follow-up. Seizure occured while playing video game. In February 2012 side effects of Keppra were suspected.


Changed on 7/14/2014

VAERS ID: 485513 Before After
Age:11.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-03
Onset:2011-11-06
Submitted:2013-02-05
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / - UN / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M10126A / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3518AA / - UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Amnesia, Aspartate aminotransferase increased, Auricular swelling, Confusional state, Convulsion, Dysarthria, Ear pain, Electroencephalogram abnormal, Epilepsy, Fatigue, Fear, Gait disturbance, Grand mal convulsion, Hallucination, visual, Lymphocyte count increased, Mean cell haemoglobin concentration increased, Mean cell volume decreased, Monocyte count increased, Mouth ulceration, Neutrophil count increased, Personality change, Rhonchi, Tonsillar hypertrophy, Tremor, Unresponsive to stimuli, Upper respiratory tract infection, White blood cell count increased, Postictal state, Cerumen impaction, Platelet count increased, Lymphocyte percentage increased, Abnormal behaviour, Adverse drug reaction, Foaming at mouth, Oropharyngeal pain, Granulocyte percentage

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None The following information was obtained through follow-up and/or provided by the government. 04/26/12 PMH: Dust allergy.
Diagnostic Lab Data: Epilepsy as a result of vaccination The following information was obtained through follow-up and/or provided by the government. 04/10/13 Labs and Diagnostics: CHEM - AST 42 U/L (H). CBC - MCV 79.4 fl (L) MCHC 33.4 g/dl (H) Gran 43.4% (L) Lymph 45.6% (H) Lymph# 6.0 (H) Mono# 0.9 (H). 04/26/13 Labs and Diagnostics: EEG - Abnormal. CBC - WBC 11.1 x10E3/uL (H) Platelets 376 x10E3/ul (H) Neut 6.3 x10E3/ul (H) Lymph 3.6 x10E3/ul (H) Mono 0.9 x10E3/ul (H).
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. The following information was obtained through follow-up and/or provided by the government. 03/27/13 PCP medical records received. Service dates 10/03/11 to 01/10/13. Diagnosis: Seizure disorder. Patient presents for periodic PCP visits for upper respiratory infections, sore throat, enlarged tonsils, mouth ulcer, rhonchi, wheezes, cerumen in ears, ear swelling, ear ache, fatigue syndrome. 04/10/13 ER records recieved. Service date 11/06/11. Diagnosis: Seizure disorder (convulsive). Child presents for evaluation of grand-mal seizure, 1-5 minutes, single episode. In post-ictal state. 04/26/13 Hospital records, consultations and discharge summary received. Service dates 11/06/11 to 11/07/11, 03/06/12 to 03/08/12. Diagnosis: Generalized Epilepsy. Patient was found unresponsive, frothy secretion from mouth, trembling by parent. Later awake but confused, slurred speech, could not walk on his own. Admitted for generalized tonic-clonic seizure. Rx for Keppra and Diastat, discharged. At a later date was admitted for video EEG monitoring due to visual hallucinations, possible seizures, and behavioral side effects from Keppra XR. Medications adjusted, discharged. 04/26/13 Consultation records received. Service dates 12/01/11 to 12/27/12. Additional information abstracted. Diagnosis: Epilepsy generalized. Patient present for seizure follow-up. Seizure occured while playing video game. In February 2012 side effects of Keppra were suspected.


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