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This is VAERS ID 307394

Case Details

VAERS ID: 307394 (history)  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-01
Onset:2007-05-25
   Days after vaccination:85
Submitted: 2008-03-19
   Days after onset:299
Entered: 2008-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Amyotrophic lateral sclerosis, Electromyogram abnormal, Lumbar puncture, Muscular weakness, Nerve conduction studies abnormal, Neuropathy, Nuclear magnetic resonance imaging, Paralysis flaccid, Respiratory failure, Sleep study abnormal, Swelling, Urinary incontinence, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? Yes
Died? Yes
   Date died: 2009-03-15
   Days after onset: 660
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 24 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none 4/8/08-recor ds received-PMH: attention deficit hyperactivity disorder and congenital strabismus. Migraines. Cognitive delay, developmental delay and motor delay. Allergies:strawberries cause an itch. In May sustained injury with pain in leg which improved but never returned completely to normal. 4/16/08-records received-PMH: Pityriasis lichennoides. Allergy to strawberries causes itching. Attention deficit disorder.
Diagnostic Lab Data: EMG and nerve conduction studies suggest motor neuronopathy vs neuropathy 4/8/09-records received- EEG normal. MRI brain showed slightly prominent cerebellar fissures but otherwise normal. MRI spine normal. West Nile, hepatitis B were negative. Urine organic acids elevated lactic acid. T4 and TSH normal. Heavy metal screen normal. Acylcarnitine profile normal. CSF protein elevated 54, lymphocytes 86 and monocytoid cells 14. CSF amino acids showed nonspecific variations from normal of serine, alanine, citrulline, valine, methionine, beta aminoisobutyric acid, lysine and histidine. triglycerides 429. December 2007 EMG and nerve conduction studies with dignosis of multifocal motor neuropathy. MRI at that time showed nerve root enhancement. 4/
CDC Split Type:

Write-up: Progressive muscle weakness resulting in flaccid paresis of all 4 extremities, respiratory insufficiency. 4/8/08-records received for DOS 2/4-2/17/08-DC DX: autoimmune motor neuropathy, provisional. Possible motor neuron disease. Admission 3/14-3/25/08-DC DX: Muscular weakness. Seizures. Received IVIG, treated with plasmapheresis. Admitted with C/O progressive muscular weakness over the 3 weeks prior to admission increased immunomodulation. Seizure after completion of solumedrol. Remained post ictal for several hours. No diagnosis made during this admission. Genetic evaluation for mitrochondrial disease sent to include evaluation for Pompe disease. In May sustained injury with pain in leg which improved but never returned completely to normal. Developed worsening limping and loss of strength in distal left lower extremity. Between August and October of 2007 developed symptoms in right arm. Received IVIG at that time and again January 2008 with improvement in right handed tremor but worsening function status especially in ambulation, stair climbing and standing from seated position. Feb 4-17 2008 hospitalized received plasmapheresis with improved ability to stand for short periods. C/O headaches and nausea. She may have chronic inflammatory demyelinating myopathy versus a multifocal motor neuropathy. After discharge to follow up with specialist in ALS. 4/16/08-records received-for DOS 1/2-1/3/08-DC DX: Multifocal neuropathy versus chronic demyelinating polyneuropathy. LP: mildly elevated protein of 46 with normal glucose. Unable to perform activities of daily living. IVIG treatment. PE: left lower and right upper extremity weakness and atrophy with some mild weakness of right lower extremity. 4/16/08-clinical consult case review template received: CPK increased of 313 and slightly elevated anticardiolipin IgM of 20.3. DX: chronic inflammatory demyelinating polyneuropathy. 1/2/08-urinary incontinence may have been due to her reduced ability to mobilize given her leg weakness. Plasmapheresis. 3/14/08-admitted for progressively worsening weakness and increased immunomodulation. During treatment with IV Solu-Medrol, one seizure and was post-ictal for several hours. Shortness of breath with vital capacity of 48%. Restrictive and obstructive component to her lung involvement. 4/5/08-DX: primary muscular atrophy the syndrome of progressive lower motor neuron loss. Third seizure during sleep study. Currently on a trial of Cytoxan. Impression: ten month history of progressive muscular weakness with lower motor neuron signs and status post multiple different trials of immunosuppressant medications. 4/16/08-records received-for DOS 1/2-1/3/08-DC DX: Multifocal neuropathy versus chronic demyelinating polyneuropathy.Unable to perform activities of daily living. IVIG treatment. PE: left lower and right upper extremity weakness and atrophy with some mild weakness of right lower extremity. 6/17/09 Autopsy report received from CDC - DOS 3/17/09 Clinical Diagnosis: Atypical progressive lower motor neuron disease, ventilator dependence, gastrostomy tube, hypercalcemia, seizures. I. Extensive demyelination, involving the lateral and anterior columns of the cervical, thoracic and lumbar spinal cord, with macrophage and lymphocytic infiltration. Severe loss of motor neurons, cervical, thoracic, and lumbar spinal cord. Rare neurons with amorphous cytoplasmic inclusions, frontal cortex, substantia nigra, locus ceruleus, medulla oblongata, and spinal cord. Neurogenic atropy, skeletal muscle. II. Acute brochopneumonia, lungs. III. Mild steatosis, liver. IV. Gastrostomy tube, stomach, in proper position. Follow-up: Paralysis - involving 4 extremities trunk and possibly the diaphragm given that her FVC = 27%. She also has significant persistent nausea / vomiting, intermittent abdominal pain, and extremity swelling. Her condition continues to deteriorate and now she is on BIPAP.


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