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This is VAERS ID 417338

Case Details

VAERS ID:417338 (history)  Vaccinated:2008-10-27
Age:13.0  Onset:2009-03-09, Days after vaccination: 133
Gender:Female  Submitted:2011-02-18, Days after onset: 711
Location:Unknown  Entered:2011-02-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma; Anxiety disorder; Envir allergies
Diagnostic Lab Data:
CDC 'Split Type': 2011027643
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anti-SS-B antibody positive, Antinuclear antibody positive, Optic nerve disorder, Sjogren's syndrome
SMQs:, Systemic lupus erythematosus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Optic nerve disorders (narrow), Lacrimal disorders (narrow)
Write-up: This spontaneous report (initial receipt: 08-FEB-2011) concerns a 13 year old female patient, who had a medical history of asthma, environment allergies and an anxiety disorder. The patient did not have any illness at the time of vaccination. On 27-OCT-2008 the patient received a Flu vaccine (brand name unspecified). The patient also received intramuscular GARDASIL (batch number: 0279X) on the same day. She received her third dose of GARDASIL (batch number: 0570X) on 26-MAY-2009. On 09-MAR-2009, 134 days after flu vaccination, the patient was found to have elevated optic nerve (on examination). Subsequently she had a positive ANA test twice and elevated anti-SSB antibody associated with Sjogren''s syndrome, but no eye symptoms. The patient outcome was not provided.

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