Age: 17.0
Sex: F
Vaccine: DTAP, HPV4, IPV, MNQ, HPV4, MNQ, TDAP
Symptoms: Headache, Lymphocyte count decreased, Lymphocyte percentage decreased, Metabolic function test, Neutrophil count increased
Clinical narrative: Initial report was received on 02 May 2008 from a physician.  A 17-year-old female patient, who had no known allergies, or concurrent illnesses, but who had a history of chronic constipation, had received on 28 April 2008 a first intramuscular dose of MENACTRA (Lot # U2604AA); a dose of "Tdap" (trade name and manufacturer name not provided, Lot # AC52B016BA [not a valid Sanofi Pasteur lot number]); and a first dose of GARDASIL (manufacturer Merck, Lot # M1758A).  The routes and sites of administration were not provided for the "Tdap" or GARDASIL; and the site of administration was not provided for the MENACTRA.  Three days post-vaccination, the patient complained of severe headache and fever of 102.2 degrees Fahrenheit.  The patient was taken to the emergency room that day.  A CAT scan of the head was performed that was negative; and the patient was treated with DARVON for her severe headache.  The following day, the patient was seen in the physician's office with continued severe headache and fever of 101.6 degree Fahrenheit.  Diagnostic tests and treatments received were not provided.  At the time of this report, the patient had not recovered.  Follow-up information was received on 27 May 2008 from the original reporting physician.  On 28 April 2008 the patient had received a first intramuscular right deltoid injection of MENACTRA, lot # U2604AA; a first intramuscular left deltoid injection of BOOSTRIX (previously reported as "Tdap"), manufacturer GlaxoSmithKline, Lot # AC52B06BAA also reported as AC52B020AA (previously reported as AC52B016BA); and a first intramuscular right deltoid injection of GARDASIL, manufacturer Merck, Lot # M1758U (Lot # previously reported as M1758A).  On 01 May 2008, i.e. three days post-vaccination, the patient went to the emergency room as reported in the above narrative.  During that emergency room visit, the patient had blood work completed that included a Complete Blood Count and a Complete Metabolic Panel, in addition to the CAT scan of the head which was negative.  The results of those blood tests were not provided.  The patient received corrective treatment with intravenous fluids, DEMEROL, ZOFRAN, and DILAUDID.  She was released from the emergency room the same day.  The following day, the patient was seen in the physicians office with severe headache and fever of 101.6 degrees Fahrenheit.  One hour prior to the office visit she took an ALEVE with no relief; and was subsequently given TYLENOL in the office.  One hour after receiving the TYLENOL, the patient started vomiting.  Her blood pressure reading was 96/66 mmHg.  At that time it was questionable whether the patient was having side effects of ACCUTANE (started one week prior) or the vaccines administered on 28 April 2008.  The patient was diagnosed with headache, fever, vomiting, and dehydration and was admitted to the hospital the same day.  She received corrective treatment of intravenous fluids and ALEVE.  A Complete Metabolic Panel revealed blood urea nitrogen 5 mg/dL, and creatinine 0.8mg/dL.  A Complete Blood Count revealed white blood cells 9.9 Ku/L, and bands 1%.  A Celiac Panel IgA, serum revealed 205 mg/dL (range 80-450 mg/dL).  Blood cultures were performed, but the results were not provided.  The date of discharge from the hospital was not provided.  The patient was reported as being recovered on 05 May 2008, four days after onset of symptoms.  Per this new information, the case was upgraded to serious.