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This is VAERS ID 422164

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

422164
VAERS Form:
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-11
Onset:0000-00-00
Submitted:2011-05-03
Entered:2011-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: CSF oligoclonal band present, Demyelination, Encephalopathy, Lumbar puncture, Multiple sclerosis, Nuclear magnetic resonance imaging brain abnormal, Visual acuity reduced, Visual evoked potentials abnormal, Wheelchair user, Multiple sclerosis relapse, Central nervous system lesion, Walking disability, Neurological examination abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Spinal tap, ??Oct?10, Oligoclonal bands; Neurological examination, ??Oct?10, Abnormal results; Magnetic resonance imaging, ??Oct?10, Suspected acute demyelinating encephalopathy; Visual evoked potential, ??Oct?10, Abnormal
CDC 'Split Type': WAES1104USA04016

Write-up:Case received from a consumer on 18-APR-2011. Case not medically confirmed. A 15 year old female patient had received a first dose of GARDASIL (batch number not reported) on an unspecified date and following vaccination the patient developed multiple sclerosis experiencing 3 relapses in 2 months. According to the reporter, the patient''s father, the patient had serious sequelae. Additional information received from the Health Authorities on 22-APR-2011 under the reference number BX20110458. Case medically confirmed. The patient had received a first dose of GARDASIL (batch number not reported) intramuscularly on 11-OCT-2010 and experienced the first symptoms 2 to 3 weeks after vaccination. The patient had experienced 4 acute demyelinating attacks since that time. An MRI was performed resulting in suspect acute demyelinating encephalopathy with lesions, a lumbar puncture revealed oligoclonal bands and a neurological examination showed abnormal results. Visual evoked potentials were altered. The patient was diagnosed with multiple sclerosis. The patient would had been hospitalized twice (to be confirmed) and she received twice 3 days of corticosteroid bolus IV injection. The patient received a second dose of GARDASIL (batch number not reported) on 13-DEC-2010. Patient''s family medical history included her brother, father and grand father with insulin dependent diabetes mellitus and cousins with immune dysfunction disease. At then time of the reporting, the patient had not recovered and the outcome was reduced visual acuity and walking disability: wheelchair user. The Health Authorities assessed the causal relationship between the reported reaction and vaccination as doubtful (C1 S1 11) according to the method of assessment. Multiple sclerosis was considered by agency to be disabling. Other business partner numbers included: E2011-2535. No further information is available.


Changed on 6/14/2014

422164 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-11
Onset:0000-00-00
Submitted:2011-05-03
Entered:2011-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: CSF oligoclonal band present, Demyelination, Encephalopathy, Lumbar puncture, Multiple sclerosis, Nuclear magnetic resonance imaging brain abnormal, Visual acuity reduced, Visual evoked potentials abnormal, Wheelchair user, Multiple sclerosis relapse, Central nervous system lesion, Walking disability, Neurological examination abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Spinal tap, ??Oct?10, Oligoclonal bands; Neurological examination, ??Oct?10, Abnormal results; Magnetic resonance imaging, ??Oct?10, Suspected acute demyelinating encephalopathy; Visual evoked potential, ??Oct?10, Abnormal
CDC 'Split Type': WAES1104USA04016

Write-up:Case received from a consumer on 18-APR-2011. Case not medically confirmed. A 15 year old female patient had received a first dose of GARDASIL (batch number not reported) on an unspecified date and following vaccination the patient developed multiple sclerosis experiencing 3 relapses in 2 months. According to the reporter, the patient''s father, the patient had serious sequelae. Additional information received from the Health Authorities on 22-APR-2011 under the reference number BX20110458. Case medically confirmed. The patient had received a first dose of GARDASIL (batch number not reported) intramuscularly on 11-OCT-2010 and experienced the first symptoms 2 to 3 weeks after vaccination. The patient had experienced 4 acute demyelinating attacks since that time. An MRI was performed resulting in suspect acute demyelinating encephalopathy with lesions, a lumbar puncture revealed oligoclonal bands and a neurological examination showed abnormal results. Visual evoked potentials were altered. The patient was diagnosed with multiple sclerosis. The patient would had been hospitalized twice (to be confirmed) and she received twice 3 days of corticosteroid bolus IV injection. The patient received a second dose of GARDASIL (batch number not reported) on 13-DEC-2010. Patient''s family medical history included her brother, father and grand father with insulin dependent diabetes mellitus and cousins with immune dysfunction disease. At then time of the reporting, the patient had not recovered and the outcome was reduced visual acuity and walking disability: wheelchair user. The Health Authorities assessed the causal relationship between the reported reaction and vaccination as doubtful (C1 S1 11) according to the method of assessment. Multiple sclerosis was considered by agency to be disabling. Other business partner numbers included: E2011-2535. No further information is available.


Changed on 4/14/2017

422164 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-11
Onset:0000-00-00
Submitted:2011-05-03
Entered:2011-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: CSF oligoclonal band present, Demyelination, Encephalopathy, Lumbar puncture, Multiple sclerosis, Nuclear magnetic resonance imaging brain abnormal, Visual acuity reduced, Visual evoked potentials abnormal, Wheelchair user, Multiple sclerosis relapse, Central nervous system lesion, Walking disability, Neurological examination abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Spinal tap, ??Oct?10, Oligoclonal bands; Neurological examination, ??Oct?10, Abnormal results; Magnetic resonance imaging, ??Oct?10, Suspected acute demyelinating encephalopathy; Visual evoked potential, ??Oct?10, Abnormal
CDC 'Split Type': WAES1104USA04016

Write-up:Case received from a consumer on 18-APR-2011. Case not medically confirmed. A 15 year old female patient had received a first dose of GARDASIL (batch number not reported) on an unspecified date and following vaccination the patient developed multiple sclerosis experiencing 3 relapses in 2 months. According to the reporter, the patient''s father, the patient had serious sequelae. Additional information received from the Health Authorities on 22-APR-2011 under the reference number BX20110458. Case medically confirmed. The patient had received a first dose of GARDASIL (batch number not reported) intramuscularly on 11-OCT-2010 and experienced the first symptoms 2 to 3 weeks after vaccination. The patient had experienced 4 acute demyelinating attacks since that time. An MRI was performed resulting in suspect acute demyelinating encephalopathy with lesions, a lumbar puncture revealed oligoclonal bands and a neurological examination showed abnormal results. Visual evoked potentials were altered. The patient was diagnosed with multiple sclerosis. The patient would had been hospitalized twice (to be confirmed) and she received twice 3 days of corticosteroid bolus IV injection. The patient received a second dose of GARDASIL (batch number not reported) on 13-DEC-2010. Patient''s family medical history included her brother, father and grand father with insulin dependent diabetes mellitus and cousins with immune dysfunction disease. At then time of the reporting, the patient had not recovered and the outcome was reduced visual acuity and walking disability: wheelchair user. The Health Authorities assessed the causal relationship between the reported reaction and vaccination as doubtful (C1 S1 11) according to the method of assessment. Multiple sclerosis was considered by agency to be disabling. Other business partner numbers included: E2011-2535. No further information is available.


Changed on 9/14/2017

422164 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-11
Onset:0000-00-00
Submitted:2011-05-03
Entered:2011-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: CSF oligoclonal band present, Demyelination, Encephalopathy, Lumbar puncture, Multiple sclerosis, Nuclear magnetic resonance imaging brain abnormal, Visual acuity reduced, Visual evoked potentials abnormal, Wheelchair user, Multiple sclerosis relapse, Central nervous system lesion, Walking disability, Neurological examination abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Spinal tap, ??Oct?10, Oligoclonal bands; Neurological examination, ??Oct?10, Abnormal results; Magnetic resonance imaging, ??Oct?10, Suspected acute demyelinating encephalopathy; Visual evoked potential, ??Oct?10, Abnormal
CDC 'Split Type': WAES1104USA04016

Write-up:Case received from a consumer on 18-APR-2011. Case not medically confirmed. A 15 year old female patient had received a first dose of GARDASIL (batch number not reported) on an unspecified date and following vaccination the patient developed multiple sclerosis experiencing 3 relapses in 2 months. According to the reporter, the patient''s father, the patient had serious sequelae. Additional information received from the Health Authorities on 22-APR-2011 under the reference number BX20110458. Case medically confirmed. The patient had received a first dose of GARDASIL (batch number not reported) intramuscularly on 11-OCT-2010 and experienced the first symptoms 2 to 3 weeks after vaccination. The patient had experienced 4 acute demyelinating attacks since that time. An MRI was performed resulting in suspect acute demyelinating encephalopathy with lesions, a lumbar puncture revealed oligoclonal bands and a neurological examination showed abnormal results. Visual evoked potentials were altered. The patient was diagnosed with multiple sclerosis. The patient would had been hospitalized twice (to be confirmed) and she received twice 3 days of corticosteroid bolus IV injection. The patient received a second dose of GARDASIL (batch number not reported) on 13-DEC-2010. Patient''s family medical history included her brother, father and grand father with insulin dependent diabetes mellitus and cousins with immune dysfunction disease. At then time of the reporting, the patient had not recovered and the outcome was reduced visual acuity and walking disability: wheelchair user. The Health Authorities assessed the causal relationship between the reported reaction and vaccination as doubtful (C1 S1 11) according to the method of assessment. Multiple sclerosis was considered by agency to be disabling. Other business partner numbers included: E2011-2535. No further information is available.


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