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This is VAERS ID 280436

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

280436
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Borrelia burgdorferi serology

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired)


Changed on 12/8/2009

280436 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Fatigue, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal, Visual acuity reduced, Borrelia burgdorferi serology, Laboratory test, Scan thyroid gland

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


Changed on 12/7/2010

280436 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Fatigue, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal, Visual acuity reduced, Borrelia burgdorferi serology, Laboratory test, Scan thyroid gland

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge discharge.
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


Changed on 4/13/2011

280436 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Fatigue, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal, Visual acuity reduced, Borrelia burgdorferi serology, Laboratory test, Scan thyroid gland

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge.
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


Changed on 5/13/2011

280436 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Fatigue, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal, Visual acuity reduced, Borrelia burgdorferi serology, Laboratory test, Scan thyroid gland

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge.
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


Changed on 6/11/2011

280436 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Fatigue, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal, Visual acuity reduced, Borrelia burgdorferi serology, Laboratory test, Scan thyroid gland

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge.
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


Changed on 5/14/2017

280436 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blindness, Colour blindness, Eye pain, Fatigue, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal, Visual acuity reduced, Borrelia burgdorferi serology, Laboratory test, Scan thyroid gland

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge.
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


Changed on 9/14/2017

280436 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Connecticut
Vaccinated:2007-03-15
Onset:2007-05-13
Submitted:2007-05-25
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 1 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC14BD40CA / 0 1 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Eye pain, Full blood count, Headache, Lumbar puncture, Nuclear magnetic resonance imaging, Optic neuritis, Papilloedema, Positron emission tomogram normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: obesity, insulin resistance, depression records received 7/18/07-PMH: Hallucinations and previous inpatient admissions to institute of living. Depression and ADHD.
Allergies:
Diagnostic Lab Data: MRI, PET scans, spinal tap, CBC, thyroid can Oligopeptides, Lyme records received 7/18/07-CT negative. MRI brain and spine normal exception of some slight enlargement of left optic nerve. Labs unremarkable. CSF pending at time of discharge.
CDC 'Split Type':

Write-up:Optic neuritis-hospitalized for 5 day course of prednisone. Onset 5/13. Hospitalized 5/18/07 (headache, eye pain, papilledema) (color blind and visually severly impaired) 7/18/07-records received from facility for DOS 5/19-5/24/07- DC DX: Optic neuritis. One week piror to admission developed pain and vision loss in left eye accompanied by headache. Seen by ophthalmologist who diagnosed disk edema and afferent pupillary defect on left side. Fatigue for 2 months since about the time she received her tetanus and HPV vaccines. No diplopia. No viual changes in right eye. PE: Pain on left eye with ocular movements. Tender globe in periorbital region on left side, afferent pupillary defect on left.


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