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This is VAERS ID 305693

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

305693
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Back pain, Culture urine positive, CSF test normal, Arteriogram normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 wh"ere pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity ple


Changed on 12/8/2009

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''''s patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 wh"ere where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity ple plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab


Changed on 1/5/2010

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab rehab. 1/20/2010 Brittney stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week.


Changed on 2/5/2010

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Laboratory test abnormal, Monoplegia, Leukoencephalomyelitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Brittney Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 7/31/2010

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Laboratory test abnormal, Monoplegia, Leukoencephalomyelitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 4/13/2011

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 5/13/2011

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 6/11/2011

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 6/14/2014

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 9/14/2014

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) TD ADSORBED (DITANRIX) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 4/14/2017

305693 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / UN
TD: TD ADSORBED (DITANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / - LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Asthenia, Back pain, Culture urine positive, Dysuria, Hyporeflexia, Laboratory test abnormal, Monoplegia, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Urinary incontinence, Urinary tract infection, Leukoencephalomyelitis, Walking aid user, CSF test normal, Arteriogram normal, Weight bearing difficulty

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


Changed on 9/14/2017

305693 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-08-13
Onset:2007-09-02
Submitted:2008-02-26
Entered:2008-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 1 LA / UN
TD: TD ADSORBED (DITANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / - UNK LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Anterior spinal artery syndrome, Laboratory test abnormal, Monoplegia, Leukoencephalomyelitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 13     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. Allergic to PCN and Septra.
Allergies:
Diagnostic Lab Data: Tests confirmed acute disseminated encephalomyelitis (ADEM). Labs and Diagnostics: Spinal Arteriogram revealed no AV malformations. MR of spine c/w inflammatory process /demyelination. UC (+) for E. coli and Enterobacter. CSF WNL.
CDC 'Split Type':

Write-up:On September 2, 2007, patient''s left leg became paralyzed. She was taken to the emergency room and hospitalized for 13 days. The doctors at hospital diagnosed her with non-infectious A.D.E.M. 04/11/2008 MR received from hospital for DOS 9/6-10/2008 where pt was sent for diagnostic testing to r/o AVM. D/C DX: was Spinal cord anterior spinal artery infarct. Pt was transfered to another facility where Final DX was made. Pt initially had presented to local facility with sudden onset L lower extremity plegia. 04/28/2008 MR received for DOS 9/10-15/2007 with D/C DX: Acute Demyelinating Encephalomyelitis (ADEM). Urinary Tract infection. Pt admitted after transfer from above admission. Pt initially presented with Left leg weakness/paralysis and upper back pain. Upon admission pt was unable to void and later had urinary incontinence. Tx with solumedrol and abx for UTI. At D/C pt still with decreased strength of LLE, depressed reflexes and unable to bear weight independantly. Using a walker. Will continue with Outpt rehab. 1/20/2010 Patient stil has not been able to walk or run normal. She is still receiving physical therapy 2x a week. Follow-up Information 06-MAY-2008:


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