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This is VAERS ID 375798

History of Changes from the VAERS Wayback Machine

First Appeared on 1/5/2010

VAERS ID: 375798
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME - BRAND NAME UNKNOWN) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Myelitis transverse, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + f
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 4/7/2010

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME - BRAND NAME UNKNOWN) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Myelitis transverse, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + f
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 8/31/2010

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME - BRAND NAME UNKNOWN) INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Difficulty in walking, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Myelitis transverse, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Leukoencephalomyelitis, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + f
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 12/7/2010

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Difficulty in walking, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Myelitis transverse, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Leukoencephalomyelitis, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + f for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 1/4/2011

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Myelitis transverse, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 4/13/2011

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Anxiety, Asthenia, Ataxia, Back pain, Blood creatine phosphokinase normal, Blood culture negative, CSF oligoclonal band present, CSF protein increased, Culture urine negative, Dehydration, Demyelination, Diplopia, Disturbance in attention, Electroencephalogram normal, Fatigue, Full blood count abnormal, Gait disturbance, Goitre, Headache, Hepatitis A antibody positive, Hypoaesthesia, Lumbar puncture, Micturition urgency, Mononucleosis heterophile test negative, Myalgia, Nausea, Neutrophil count increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Pollakiuria, Pregnancy test negative, Thyroid function test normal, Thyroid neoplasm, Tremor, Urinary incontinence, Vaccination complication, Vision blurred, Vomiting, White blood cell count increased, Rheumatoid factor negative, Abasia, Dysstasia, Activities of daily living impaired, HIV antibody negative, CSF test abnormal, CSF myelin basic protein increased, Ultrasound thyroid abnormal, Urine analysis normal, Metabolic function test, Neuropsychological test

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 5/13/2011

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Anxiety, Asthenia, Ataxia, Back pain, Blood creatine phosphokinase normal, Blood culture negative, CSF oligoclonal band present, CSF protein increased, Culture urine negative, Dehydration, Demyelination, Diplopia, Disturbance in attention, Electroencephalogram normal, Fatigue, Full blood count abnormal, Gait disturbance, Goitre, Headache, Hepatitis A antibody positive, Hypoaesthesia, Lumbar puncture, Micturition urgency, Mononucleosis heterophile test negative, Myalgia, Nausea, Neutrophil count increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Pollakiuria, Pregnancy test negative, Thyroid function test normal, Thyroid neoplasm, Tremor, Urinary incontinence, Vaccination complication, Vision blurred, Vomiting, White blood cell count increased, Rheumatoid factor negative, Abasia, Dysstasia, Activities of daily living impaired, HIV antibody negative, CSF test abnormal, CSF myelin basic protein increased, Ultrasound thyroid abnormal, Urine analysis normal, Metabolic function test, Neuropsychological test

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 6/11/2011

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Anxiety, Asthenia, Ataxia, Back pain, Blood creatine phosphokinase normal, Blood culture negative, CSF oligoclonal band present, CSF protein increased, Culture urine negative, Dehydration, Demyelination, Diplopia, Disturbance in attention, Electroencephalogram normal, Fatigue, Full blood count abnormal, Gait disturbance, Goitre, Headache, Hepatitis A antibody positive, Hypoaesthesia, Lumbar puncture, Micturition urgency, Mononucleosis heterophile test negative, Myalgia, Nausea, Neutrophil count increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Pollakiuria, Pregnancy test negative, Thyroid function test normal, Thyroid neoplasm, Tremor, Urinary incontinence, Vaccination complication, Vision blurred, Vomiting, White blood cell count increased, Rheumatoid factor negative, Abasia, Dysstasia, Activities of daily living impaired, HIV antibody negative, CSF test abnormal, CSF myelin basic protein increased, Ultrasound thyroid abnormal, Urine analysis normal, Metabolic function test, Neuropsychological test

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 7/7/2013

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Anxiety, Asthenia, Ataxia, Back pain, Blood creatine phosphokinase normal, Blood culture negative, CSF oligoclonal band present, CSF protein increased, Culture urine negative, Dehydration, Demyelination, Diplopia, Disturbance in attention, Electroencephalogram normal, Fatigue, Full blood count abnormal, Gait disturbance, Goitre, Headache, Hepatitis A antibody positive, Hypoaesthesia, Lumbar puncture, Micturition urgency, Mononucleosis heterophile test negative, Myalgia, Nausea, Neutrophil count increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Pollakiuria, Pregnancy test negative, Thyroid function test normal, Thyroid neoplasm, Tremor, Urinary incontinence, Vaccination complication, Vision blurred, Vomiting, White blood cell count increased, Rheumatoid factor negative, Abasia, Dysstasia, Activities of daily living impaired, HIV antibody negative, CSF test abnormal, CSF myelin basic protein increased, Ultrasound thyroid abnormal, Urine analysis normal, Metabolic function test, Neuropsychological test

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 6/14/2014

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Anxiety, Asthenia, Ataxia, Back pain, Blood creatine phosphokinase normal, Blood culture negative, CSF oligoclonal band present, CSF protein increased, Culture urine negative, Dehydration, Demyelination, Diplopia, Disturbance in attention, Electroencephalogram normal, Fatigue, Full blood count abnormal, Gait disturbance, Goitre, Headache, Hepatitis A antibody positive, Hypoaesthesia, Lumbar puncture, Micturition urgency, Mononucleosis heterophile test negative, Myalgia, Nausea, Neutrophil count increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Pollakiuria, Pregnancy test negative, Thyroid function test normal, Thyroid neoplasm, Tremor, Urinary incontinence, Vaccination complication, Vision blurred, Vomiting, White blood cell count increased, Rheumatoid factor negative, Abasia, Dysstasia, Activities of daily living impaired, HIV antibody negative, CSF test abnormal, CSF myelin basic protein increased, Ultrasound thyroid abnormal, Urine analysis normal, Metabolic function test, Neuropsychological test

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 3/14/2015

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Anxiety, Asthenia, Ataxia, Back pain, Blood creatine phosphokinase normal, Blood culture negative, CSF oligoclonal band present, CSF protein increased, Culture urine negative, Dehydration, Demyelination, Diplopia, Disturbance in attention, Electroencephalogram normal, Fatigue, Full blood count abnormal, Gait disturbance, Goitre, Headache, Hepatitis A antibody positive, Hypoaesthesia, Lumbar puncture, Micturition urgency, Mononucleosis heterophile test negative, Myalgia, Nausea, Neutrophil count increased, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Pollakiuria, Pregnancy test negative, Thyroid function test normal, Thyroid neoplasm, Tremor, Urinary incontinence, Vaccination complication, Vision blurred, Vomiting, White blood cell count increased, Rheumatoid factor negative, Abasia, Dysstasia, Activities of daily living impaired, HIV antibody negative, CSF test abnormal, CSF myelin basic protein increased, Ultrasound thyroid abnormal, Urine analysis normal, Metabolic function test, Neuropsychological test

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 12/14/2016

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


Changed on 2/14/2017

VAERS ID: 375798 Before After
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2009-09-17
Onset:2009-09-21
Submitted:2010-01-04
Entered:2010-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR U3197AB / 0 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334DA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0654X / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2846AA / 0 RA / IM

Administered by: Unknown      Purchased by: Other
Symptoms: Acute disseminated encephalomyelitis, Asthenia, Dehydration, Fatigue, Gait disturbance, Goitre, Headache, Hypoaesthesia, Lumbar puncture, Myalgia, Nausea, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Paraesthesia, Vaccination complication, Vision blurred, Vomiting, Abasia, Dysstasia, Ultrasound thyroid abnormal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: None Allergies: NKDA
Diagnostic Lab Data: Blood work to rule out virus all normal Spinal Tap to rule out virus/Multiple Sclerosis no virus detected MRI of Spine and Brain -- confirmed A.D.E.M. Labs: RA factor wnl, HIV negative, Hepatitis A AB +, csf noted ollgocional bands, + for elevated protein, CBC wbc and neutrophil counts high, CMP, CPK, Thyroid studies, UA, Monospot, Influenza A and B all negative, blood and urine cultures negative, serum HCG neg Dx studies: EEG wnl, US of thyroid noted multifocal nodes
CDC 'Split Type': FL

Write-up:9/21/2009 Sent home from school bad headache, nausea, muscle aches, weakness. 9/29/2009 not allowed to give blood came home early from school nausea & vomiting weak feels numbness all over 9/30/2009 stayed home from school, weak nausea & vomiting feels weak, numbness in legs, difficulty walking 10/1/2009 home from school tingling from trunk into legs, weak, nausea vomiting, difficulty walking 10/2/2009 Back to school, tired weak, numbness 10/3/2009 Resumed vomiting again in the evening 10/5/2009 to pediatrician difficulty walking, nausea, weakness 10/6/2009 ER RX Zofran for nausea sent home 10/7/2009 ER IV hydration sent home 10/8/2009 weakness worsens 10/9/2009 to pediatrician vomiting dehydrated admitted to hospital from pediatrician''s office unable to walk/stand. Dr. noted enlarged thyroid U/S thyroid and abdominal -- normal Ct Scan abdomen -- normal 10/10 Blurred vision in left eye 10/11/2009 MRI back -- transverse myelitis 10/12/2009 MRI brain--lesions in brain consistent with A.D.E.M. Spinal tap and start IV Steroids transfer to Hospital 10/13/2009 Diagnosed with Acute Disseminated Encephalomyelitis and Transverse Myelitis Infectious Disease ruled out a viral cause and states consistent with vaccination reaction. 11/05/2009 Consultation at Hospital Multiple Sclerosis Center and A.D.E.M. diagnosis confirmed by pediatric neurologist. 1/6/2010 ED records for 10/6 and 10/8/2009 patient with c/o''s nausea/vomiting and diarrhea, IVF, IV Zofran 1/6 and 1/7/2010 MR for 10/9-10/12/2009 patient admitted nausea. vomiting and progressive weakness transferred to another facility for continued care on 10/12/2009 1/6/2010 MR and DC summary for 10/12-10/16/2009, patient with c/o''s numbness, weakness, ataxia, nausea/vomiting, tingling and hand tremors, diplopia LP, Neuro and Opthalmology, ID consults, IV Solu-Medrol x 5 days with resolution of sx. dc''d home on steroid taper and f/up with PCP DC DX: Weakness, improving. Ataxia, improving. Numbness improving. Demyelinating disease of CNS.


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