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This is VAERS ID 417338

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2011

VAERS ID: 417338
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2008-10-27
Onset:2009-03-09
Submitted:2011-02-18
Entered:2011-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sjogren's syndrome, Antinuclear antibody positive, Anti-SS-B antibody positive, Optic nerve disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma; Anxiety disorder; Envir allergies
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.


Changed on 7/7/2013

VAERS ID: 417338 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2008-10-27
Onset:2009-03-09
Submitted:2011-02-18
Entered:2011-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / - - / -
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sjogren's syndrome, Antinuclear antibody positive, Anti-SS-B antibody positive, Optic nerve disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma; Anxiety disorder; Envir allergies
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.


Changed on 9/14/2017

VAERS ID: 417338 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2008-10-27
Onset:2009-03-09
Submitted:2011-02-18
Entered:2011-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sjogren's syndrome, Antinuclear antibody positive, Anti-SS-B antibody positive, Optic nerve disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma; Anxiety disorder; Envir allergies
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.


Changed on 2/14/2018

VAERS ID: 417338 Before After
VAERS Form:1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2008-10-27
Onset:2009-03-09
Submitted:2011-02-18
Entered:2011-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sjogren's syndrome, Antinuclear antibody positive, Anti-SS-B antibody positive, Optic nerve disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma; Anxiety disorder; Envir allergies
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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