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This is VAERS ID 417338

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 417338 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:133
Submitted: 2011-02-18
   Days after onset:711
Entered: 2011-02-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? 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

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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