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This is VAERS ID 348729

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

348729
VAERS Form:
Age:13.0
Gender:Female
Location:Michigan
Vaccinated:2007-06-12
Onset:2009-03-01
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protei
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 10/5/2010

348729 Before After
VAERS Form:
Age:13.0 15.0
Gender:Female
Location:Michigan
Vaccinated:2007-06-12 2009-03-05
Onset:2009-03-01
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protei
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 1/4/2011

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2009-03-05
Onset:2009-03-01
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Asthenia, Blood product transfusion, Demyelination, Pain in extremity

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protei Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 2/4/2011

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2009-03-05 2006-11-14
Onset:2009-03-01 2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Asthenia, Blood product transfusion, Demyelination, Pain in extremity

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 4/13/2011

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2006-11-14
Onset:2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 5/13/2011

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2006-11-14
Onset:2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 6/11/2011

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2006-11-14
Onset:2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 6/14/2014

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2006-11-14
Onset:2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 4/14/2017

348729 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2006-11-14
Onset:2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Areflexia, Arthralgia, Asthenia, Blood product transfusion, CSF culture negative, CSF protein increased, Demyelination, Electromyogram abnormal, Fatigue, Hepatitis B antibody, Influenza, Muscular weakness, Pain in extremity, Joint range of motion decreased, Dysstasia, Specific gravity urine increased, Crystal urine, Protein urine present, Urine ketone body present, Chronic inflammatory demyelinating polyradiculoneuropathy, Bacteria urine

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


Changed on 9/14/2017

348729 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2006-11-14
Onset:2009-03-05
Submitted:2009-06-08
Entered:2009-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 2 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Asthenia, Blood product transfusion, Demyelination, Pain in extremity

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 8/14/2009 MR rec''d from PCP. Allergy to Ceclor and tree nuts. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Asthma, T/A, myringotomy bilateral.
Allergies:
Diagnostic Lab Data: Unknown. 8/14/2009 MR rec''d from PCP. Labs and Diagnostics: EMG abnormal. CSF protein increased. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. LABS and DIAGNOSTICS: CSF Culture - No Growth. CSF - Protein 165 mg/dL (H). Hepatitis B Surface Antibody 39.5 mIU/mL (H). Urinalysis - Ketones Trace, Sp. Grav 1.036 (H), Protein 1+. Crystals 20-50, Bacteria 1+. EMG - Abnormal.
CDC 'Split Type': WAES0906USA00536

Write-up:Information has been received from a physician concerning a 15 year old female patient who on 14-NOV-2006, 16-JAN-2007 and on 12-JUN-2007 was vaccinated with the first, second and third doses of GARDASIL (Lot # not reported). It was reported that in "March 2009" the patient experienced weakness, pain in her legs and hips and the patient sought medical attention with the physician, then she was admitted to the hospital for three days on 07-APR-2009. It was reported that the patient was diagnosed with "acute demyelinating disease". The physician noted that the patient received gamma globulin for three days. It was reported that the patient was recovering but not fully recovered. The reporting physician considered "acute demyelinating disease" to be disabling. The Health Care Professional contacted during telephone follow up could not supply the following information: patient name and Lot numbers. Additional information has been requested. The patient was hospitalized. 8/14/2009 MR rec''d from PCP which includes Neuro consult in f/u to hospitalization with DX: CIDP/sub-acute polyradiculopathy. Pt developed fever, cough, cold sx, abdominal pain, H/A and stuffy ears 2/9/2009. Flu (+). Dx: Viral Flu. Returned 3/5/09 with c/o hip pain, numbness/weakness in both feet, muscle stiffness. Had recent knee injury. Worsening by 4/2/09 and referred to neurologist. Admitted 4/23-29 with dx CIDP. Tx IVIG. Neuro f/u 5/22/09 with almost complete resolution of sx. 9/1/09 Hospital records received DOS 4/23/09 to 4/29/09 and 5/21/09 to 6/21/09. Assessment: Chronic Inflammatory Demyelinating Polyneuropathy (possibly secondary to influenza illness) Patient presents with bilateral upper and lower extremity weakness, influenza diagnosed 2/10/09. Fatigue, bilateral hip and calf pain. Range of motion decreased in lower extremiities. Reflexes absent. Wide-based stance. IVIG. Improved.


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