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This is VAERS ID 671888

Case Details

VAERS ID: 671888 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Vermont  
Vaccinated:2016-12-06
Onset:2016-12-07
   Days after vaccination:1
Submitted: 2016-12-07
   Days after onset:0
Entered: 2016-12-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI684AB / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. M016193 / 3 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Blindness transient, Dizziness, Head injury, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No illness
Preexisting Conditions: Entoptic phenomenon; no other dxs; no allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received vaccine 12/6/16 no adverse symptoms or events until 12/7/16 at 0515 while pt in shower. Pt began to feel lightheaded, dizzy, (+) blurred vision. About 30 sec couldn''t see. No LOC. Hit head (right side). Frontal H/A rates 2/10. Negative for N/V.


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