This is VAERS ID 417338
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| 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 | | FLU: 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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=417338
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