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This is VAERS ID 323865

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

323865
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain upper, Anger, Abasia, Angiotensin converting enzyme increased, Antibody test 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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA:
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been"quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very /"jum


Changed on 12/8/2009

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain upper, Anger, Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Full blood count, Haemoglobin normal, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Malaise, Mood altered, Muscular weakness, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Platelet count normal, Sensory loss, Social avoidant behaviour, Tremor, Vertigo, Wheelchair user, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Ultrasound abdomen normal, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, CSF test normal, Borrelia burgdorferi serology negative, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Eye movement disorder, Motor dysfunction, Antibody test normal, Blood heavy metal normal, Steroid therapy, Herpes simplex serology positive, Mycoplasma serology positive, Oropharyngeal pain

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA:
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been"quite been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very /"jum "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had


Changed on 4/7/2010

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Anger, Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Full blood count, Haemoglobin normal, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Malaise, Mood altered, Muscular weakness, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Platelet count normal, Sensory loss, Social avoidant behaviour, Tremor, Vertigo, Wheelchair user, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Ultrasound abdomen normal, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, CSF test normal, Borrelia burgdorferi serology negative, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Eye movement disorder, Motor dysfunction, Antibody test normal, Blood heavy metal normal, Steroid therapy, Herpes simplex serology positive, Mycoplasma serology positive, Oropharyngeal pain

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA:
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had


Changed on 8/31/2010

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Coordination abnormal, Electroencephalogram normal, Haemoglobin normal, Hyperglycaemia, Nausea, Platelet count normal, Social avoidant behaviour, Tremor, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Antibody test normal, Mycoplasma serology positive

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA:
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had


Changed on 1/4/2011

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Coordination abnormal, Electroencephalogram normal, Haemoglobin normal, Hyperglycaemia, Nausea, Platelet count normal, Social avoidant behaviour, Tremor, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Antibody test normal, Mycoplasma serology positive

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.


Changed on 4/13/2011

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Anger, Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Full blood count, Haemoglobin normal, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Malaise, Mood altered, Muscular weakness, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Platelet count normal, Sensory loss, Social avoidant behaviour, Tremor, Vertigo, Wheelchair user, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Ultrasound abdomen normal, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, CSF test normal, Borrelia burgdorferi serology negative, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Eye movement disorder, Motor dysfunction, Antibody test normal, Blood heavy metal normal, Herpes simplex serology positive, Mycoplasma serology positive, Oropharyngeal pain

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.


Changed on 5/13/2011

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Anger, Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Full blood count, Haemoglobin normal, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Malaise, Mood altered, Muscular weakness, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Platelet count normal, Sensory loss, Social avoidant behaviour, Tremor, Vertigo, Wheelchair user, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Ultrasound abdomen normal, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, CSF test normal, Borrelia burgdorferi serology negative, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Eye movement disorder, Motor dysfunction, Antibody test normal, Blood heavy metal normal, Herpes simplex serology positive, Mycoplasma serology positive, Oropharyngeal pain

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.


Changed on 6/11/2011

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Anger, Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Full blood count, Haemoglobin normal, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Malaise, Mood altered, Muscular weakness, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Platelet count normal, Sensory loss, Social avoidant behaviour, Tremor, Vertigo, Wheelchair user, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Ultrasound abdomen normal, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, CSF test normal, Borrelia burgdorferi serology negative, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Eye movement disorder, Motor dysfunction, Antibody test normal, Blood heavy metal normal, Herpes simplex serology positive, Mycoplasma serology positive, Oropharyngeal pain

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.


Changed on 4/14/2017

323865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Anger, Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Full blood count, Haemoglobin normal, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Malaise, Mood altered, Muscular weakness, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Platelet count normal, Sensory loss, Social avoidant behaviour, Tremor, Vertigo, Wheelchair user, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Ultrasound abdomen normal, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, CSF test normal, Borrelia burgdorferi serology negative, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Eye movement disorder, Motor dysfunction, Antibody test normal, Blood heavy metal normal, Herpes simplex serology positive, Mycoplasma serology positive, Oropharyngeal pain

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.


Changed on 9/14/2017

323865 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2008-01-30
Onset:2008-01-30
Submitted:2008-07-30
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 2 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2549AA / 0 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody negative, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood thyroid stimulating hormone normal, Cardiolipin antibody negative, Cerebellar syndrome, Electroencephalogram normal, Haemoglobin normal, Hyperglycaemia, Nausea, Platelet count normal, Social avoidant behaviour, Tremor, White blood cell count increased, Abasia, Angiotensin converting enzyme increased, Opsoclonus myoclonus, Laboratory test normal, Thyroxine free normal, Antinuclear antibody positive, Antineutrophil cytoplasmic antibody positive, Antineutrophil cytoplasmic antibody negative, Blood electrolytes normal, Antibody test normal, Mycoplasma serology positive

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: 50     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Allergies:
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper myeloperoxidase antibody PR2 <2, normal; Anticardiolipin antibody ACA IgG <23 normal; ACA IgM <11 normal; SCL 70 antibodies normal; Anti-LA antibodies 0.3 normal; Anti RO antibodies: A-RO 1.7 (high; normal is <1); Anti smith antibodies: A-SM <0.2; Anti-JO JO-1 <0.2; RNP 0.4; ACE level elevated; TSH 2.07; Free T4 1.08; both normal; WBC 17.1, high; Hgb 13.2 normal; Plts 353; Lytes normal by report from Pedi office. Labs and Diagnostics: Numerous tests performed-see medical records. Brain MRI WNL. Abd US WNL. MRI spine (-). MRI chest (-). EEG WNL. EMG/NCS WNL. CBC with WBCs 17.1. CSF WNL. Mycoplasma IgG increased, IgM (-). Lactate high at 6.6, down to 1.8. Pyruvate high at 0.66. Mitochondrial mutations (-). ANA (+) Anti-Ro Ab (+) at 1.8. Heavy metals (-). HSV igG (+), IgM (-). Lyme IgM Ab (-)
CDC 'Split Type':

Write-up:In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.


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