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This is VAERS ID 371336

Case Details

VAERS ID: 371336 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2007-03-09
Onset:2008-04-11
   Days after vaccination:399
Submitted: 2009-12-03
   Days after onset:601
Entered: 2009-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1878AA / 1 RA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood test, Lumbar puncture, Nuclear magnetic resonance imaging, Optic nerve disorder, Papilloedema, Ultrasound scan, Visual field tests, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (narrow), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO 12/04/09 PMH: right knee plica; sinusitis; acne; NKDA.
Allergies:
Diagnostic Lab Data: SPINAL TAP, BLOOD WORK, MRI, VISUAL FIELD AND ULTRASOUNDS AND BAYBE OTHERS 12/04/09 Labs/Diagnostics: MRI brain: normal; AB Bartonella: negative; Free T4: 0.73 (L); ANA: not detected; WBC 13.6 (H); CSF culture: rare WBCs; Ultrasound optic nerve: orbital echography of right eye showed enlarged optic nerve-sheath diameter with a positive 30 degree test. B-scan showed significant disc elevation; echo of left eye showed mild elevation and normal retrobulbar optic nerve with no evidence of increased subarachnoid fluid.
CDC Split Type:

Write-up: VISION PROBLEMS, SWOLLEN OPTIC NERVE, PAPILLEDEMA. WENT TO SPECIALISTS AND STARTED TESTING. HAD EYE EXAMS, ULTRASOUNDS OF EYES, SPINAL TAP, MRI, BLOOD WORK AND VISUAL FIELD. POSSIBLE OTHER TEST 12/04/09 Opthalmology records received for DOS 04/11/08-09/19/08. Pt. presents with difficulty with hand work x 1-2 weeks DX: papilledema 12/04/09 Medical records received for DOS 04/11/08, 04/16/08, 04/18/08, 04/29/08 12/04/09 Neuro-opthalmology records received for DOS 06/18/08 DX: visual fields enlarged blind spot, right eye; bilateral optic nerve drusen 12/04/09 PCP records received for DOS 03/09/07-07/10/09.


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