VAERS ID: 260144

AGE: 13| SEX: F|STATE: CA (United States)

Description

Patient received Hep A in right arm. Then received HPV in left arm. C/O pain & numbness. Started walking down hall fainted and had tonic/clonic movement for 15 sec.

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Symptoms

Hypotonia, Syncope, Pain, Hypertonia, Hypoaesthesia, Dyskinesia

Vaccines

VAX DATE: 07-25-2006| ONSET DATE: 07-25-2006| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
HEP A (VAQTA) 0 HEPA MERCK & CO. INC. 0144F UN RA
HPV (GARDASIL) 1 HPV4 MERCK & CO. INC. 0637F UN LA

RECVDATE:07-26-2006
RPT_DATE:07-25-2006
CAGE_YR:13
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:BP 90/30 90/62 110/70 110/60, BG 114 Pulse OX 99, Strep culture neg.
V_ADMINBY:PVT
OTHER_MEDS:NONE
CUR_ILL:Viral with low grade fever
HISTORY:NONE
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:PVT

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