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This is VAERS ID 493099

History of Changes from the VAERS Wayback Machine

First Appeared on 6/12/2013

VAERS ID: 493099
Age:11.0
Gender:Female
Location:Ohio
Vaccinated:2012-08-20
Onset:2012-08-29
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1167Z / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4046AA / 0 AR / IM

Administered by: Public      Purchased by: Other
Symptoms: Amnesia, Convulsion, Dizziness, Dyskinesia, Guillain-Barre syndrome, Pain, Speech disorder, Syncope, Vomiting, Abasia, Activities of daily living impaired, Abnormal behaviour, Encephalitis autoimmune

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: No she was a healthy kid
Preexisting Conditions: None
Diagnostic Lab Data: Anti-NMDA receptor encephalitis she can''t rememeber how to spell, math. She can''t get some of her words out she has seizures and she had Guillain Barre syndrome.
CDC 'Split Type':

Write-up:Vomiting dizzy fainting jerking on right side in pain then she couldn''t hardly speak acting crazy at times couldnt walk or feed herself. She got anti-NMDA receptor encephalitis from it and seizures and she Guillain Barre syndrome.


Changed on 8/12/2013

VAERS ID: 493099 Before After
Age:11.0
Gender:Female
Location:Ohio
Vaccinated:2012-08-20
Onset:2012-08-29
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1167Z / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4046AA / 0 AR / IM

Administered by: Public      Purchased by: Other
Symptoms: Amnesia, Convulsion, Dizziness, Dyskinesia, Guillain-Barre syndrome, Pain, Speech disorder, Syncope, Vomiting, Abasia, Activities of daily living impaired, Abnormal behaviour, Encephalitis autoimmune

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: (blank) 58     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: No she was a healthy kid
Preexisting Conditions: None
Diagnostic Lab Data: Anti-NMDA receptor encephalitis she can''t rememeber how to spell, math. She can''t get some of her words out she has seizures and she had Guillain Barre syndrome.
CDC 'Split Type':

Write-up:Vomiting dizzy fainting jerking on right side in pain then she couldn''t hardly speak acting crazy at times couldnt walk or feed herself. She got anti-NMDA receptor encephalitis from it and seizures and she Guillain Barre syndrome.


Changed on 9/17/2013

VAERS ID: 493099 Before After
Age:11.0
Gender:Female
Location:Ohio
Vaccinated:2012-08-20
Onset:2012-08-29
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1167Z / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4046AA / 0 AR / IM

Administered by: Public      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Agitation, Alanine aminotransferase increased, Amnesia, Anion gap decreased, Antinuclear antibody negative, Back pain, Barium swallow abnormal, Bladder dilatation, Blood albumin decreased, Blood bicarbonate decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride increased, Blood creatinine normal, Blood immunoglobulin G increased, Blood immunoglobulin M decreased, Blood magnesium increased, Blood potassium decreased, Blood urea decreased, Breast pain, Carbon dioxide decreased, Carbon dioxide increased, Complex partial seizures, Confusional state, Convulsion, CSF culture negative, CSF lymphocyte count increased, CSF oligoclonal band present, Culture throat negative, Dehydration, Diarrhoea, Dizziness, Dysarthria, Dyskinesia, Dysphagia, Electrocardiogram normal, Electroencephalogram abnormal, Enuresis, Epilepsy, Eye pain, Facial pain, Fall, Flushing, Gait disturbance, Gastritis, Guillain-Barre syndrome, Hallucination, Head injury, Headache, Hemiparesis, Hyperreflexia, Hypertonia, Hypoaesthesia, Intensive care, Lip dry, Loss of consciousness, Mastication disorder, Mucosal dryness, Multiple sclerosis, Muscle twitching, Nausea, Neck pain, Nuclear magnetic resonance imaging brain abnormal, Pain, Paraesthesia, Plasmapheresis, Pregnancy test negative, Pyrexia, Rash, Red blood cell count decreased, Red blood cells CSF positive, Red blood cells urine positive, Screaming, Sleep disorder, Speech disorder, Spinal X-ray normal, Strabismus, Syncope, Tachycardia, Tenderness, Urinary retention, Urinary tract infection, Urine abnormality, Visual evoked potentials normal, Visual impairment, Vomiting, White blood cell count decreased, White blood cell count normal, White blood cells urine positive, X-ray normal, Mental status changes, Rheumatoid factor negative, Abasia, Blood phosphorus decreased, Urine leukocyte esterase positive, Drug screen negative, Activities of daily living impaired, Parenteral nutrition, Eosinophil percentage increased, Neutrophil percentage decreased, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Central venous catheterisation, CSF white blood cell count increased, Gaze palsy, Urine ketone body present, Urine output decreased, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Angiogram normal, Psychotic disorder, Herpes simplex serology negative, Gastrointestinal sounds abnormal, Oropharyngeal pain, West Nile virus test negative, Immunoglobulin therapy, Clostridium test negative, Borrelia test negative, Parvovirus B19 test, Enterovirus test negative, Streptococcus test negative, Computerised tomogram head normal, Encephalitis autoimmune, Anti-NMDA antibody positive, Nuclear magnetic resonance imaging spinal abnormal

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 58     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: No she was a healthy kid The following information was obtained through follow-up and/or provided by the government. Bug bite around time of vaccination.
Preexisting Conditions: None The following information was obtained through follow-up and/or provided by the government. 2nd hand smoke exposure in home. Family hx MS, seizures.
Diagnostic Lab Data: Anti-NMDA receptor encephalitis she can''t rememeber how to spell, math. She can''t get some of her words out she has seizures and she had Guillain Barre syndrome. The following information was obtained through follow-up and/or provided by the government. 6/19 & 7/9/2013 lab/diagnostic records received for DOS 8/30-9/27/2012. X-ray abdomen/rt clavicle/C-spine, CT head, ECG, visual evoked potentials, MRA neck WNL. Strep, throat/CSF cx, pregnancy test, drug screen, ASO, enterovirus, HSV, ANA, RF, WNV, encephalitis, Lyme (-). UA: hazy, ketones $g80 (H). Blood: WBC 8.1 K/mm3 (N), neutros 74.9% (H), lymphs 17.4% (L), HCO3 17.3 mEq/L (L), Ca 8.8 mg/dL (L), CO2 16-28.8 mmol/L (L-H), K 3.2 mmol/L (L), bili 2.5 mg/dL (H), BUN <5 mg/dL (L), creatinin
CDC 'Split Type':

Write-up:Vomiting dizzy fainting jerking on right side in pain then she couldn''t hardly speak acting crazy at times couldnt walk or feed herself. She got anti-NMDA receptor encephalitis from it and seizures and she Guillain Barre syndrome. The following information was obtained through follow-up and/or provided by the government. 6/19/2013 ER records received for DOS 8/30/2012. D/c Dx''s: 1) syncopal episode; 2) vomiting; 3) mild dehydration. Pt c/o 2 day hx nausea, vomiting, abdominal pain, fever, syncopal episode w/ LOC/fall/head trauma, pain to side of face (from fall), neck pain. Passed out multiple times. PE: flushed skin, tacky mucous membranes, tenderness C3-5/lt forehead/lt cheek, diffuse abdominal tenderness to lower quadrants. Syncopal episode probably from vomiting & dehydration. Tx''t: IVF, antiemetic. Condition improved, pt d/c''d home w/ Rx, care, & f/u instructions. 6/19/2013 hospital records received for DOS 9/1-2/2012. D/c Dx''s: 1) dehydration; 2) gastritis. Returned w/ continued vomiting, sore throat, headaches, decreased urinary output, no appetite, confusion. PE: abdominal tenderness, slow to answer questions, mucous membranes tacky, decreased bowel sounds. Admitted. Tx''t: IVF. Pt d/c''d home in excellent condition w/ care & f/u instructions. 6/19/2013 hospital records received for DOS 9/4-15/2012. D/c Dx: MS. Pt c/o head/eye/back/rt breast pain, persistent tingling/numbness RUE, intermittent confusion, screaming, memory impairment, diarrhea, episodes of slurring & difficulty w/ speech, more quiet & w/drawn, difficulty swallowing. EMS transported pt to hospital. PE: confusion resolved, slow deliberate speech, rt side weakness, periods of poor communication, T8 tenderness, thigh twitching. Tx''t: IVF, high dose steroids, PT, OT, ST. Developed confusion, agitation, seeing lights, exotropia. Signs of steroid psychosis after 3 days - dose reduced. Pt on pureed diet due to inadequate chewing, no signs of aspiration. Pt d/c''d home in good condition w/ PT, OT, ST, care, & f/u instructions. 7/9/2013 neuro consultant records received for DOS 9/17-11/2/2012. D/c Dx: anti-NMDA encephalitis. Pt presents w/ progression of above symptoms, falls, rt sided gaze, rhythmic movements, enuresis, inability to walk & talk, abnormal behavior (pulling hair, laughing hysterically for no reason), difficulty eating solids. Presumptive Dx of MS vs ADEM. PE: tachycardia, dry lips, bladder distension, frequent intermittent non-rhythmic worm-like undulating movements of rt fingers, rt corner of mouth intermittently pulled up, reflexes more brisk in LE, difficult to assess neuro status due to pt non compliance, increased tone to LE. Admitted. Tx''t: ICU, central line, plasmapheresis, TPN, NG tube feedings, Rituximab, IVIG, anticonvulsants, PT, OT, ST. Complications: fluctuating mental status, uncontrolled agitation, deranged sleep, hallucinations, urinary retention, Pseudomonas UTI, rash. Condition improving, d/c''d to inpt rehab 11/2-12/7/2012. Pt continued improving in rehab. D/c''d home w/ care & f/u instructions. 7/9/2013 rehab & neuro consultant records received for DOS 1/30/2013. Dx''s: 1) NMDA receptor encephalitis; 2) symptomatic localization-related epilepsy. Pt seen in f/u to hospitalization. Pt having complex partial seizures (RUE flexes up, head to rt, LE tonic extension). PE: DTRs 3 @ rt patella, 2@ lt patella, lt hip flexor strength 5-, RLE steppage gait. Seizures under suboptimal control.


Changed on 3/14/2015

VAERS ID: 493099 Before After
Age:11.0
Gender:Female
Location:Ohio
Vaccinated:2012-08-20
Onset:2012-08-29
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1167Z / 0 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4046AA / 0 AR / IM

Administered by: Public      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Agitation, Alanine aminotransferase increased, Amnesia, Anion gap decreased, Antinuclear antibody negative, Back pain, Barium swallow abnormal, Bladder dilatation, Blood albumin decreased, Blood bicarbonate decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride increased, Blood creatinine normal, Blood immunoglobulin G increased, Blood immunoglobulin M decreased, Blood magnesium increased, Blood potassium decreased, Blood urea decreased, Breast pain, Carbon dioxide decreased, Carbon dioxide increased, Complex partial seizures, Confusional state, Convulsion, CSF culture negative, CSF lymphocyte count increased, CSF oligoclonal band present, Culture throat negative, Dehydration, Diarrhoea, Dizziness, Dysarthria, Dyskinesia, Dysphagia, Electrocardiogram normal, Electroencephalogram abnormal, Enuresis, Epilepsy, Eye pain, Facial pain, Fall, Flushing, Gait disturbance, Gastritis, Guillain-Barre syndrome, Hallucination, Head injury, Headache, Hemiparesis, Hyperreflexia, Hypertonia, Hypoaesthesia, Intensive care, Lip dry, Loss of consciousness, Mastication disorder, Mucosal dryness, Multiple sclerosis, Muscle twitching, Nausea, Neck pain, Nuclear magnetic resonance imaging brain abnormal, Pain, Paraesthesia, Plasmapheresis, Pregnancy test negative, Pyrexia, Rash, Red blood cell count decreased, Red blood cells CSF positive, Red blood cells urine positive, Screaming, Sleep disorder, Speech disorder, Spinal X-ray normal, Strabismus, Syncope, Tachycardia, Tenderness, Urinary retention, Urinary tract infection, Urine abnormality, Visual evoked potentials normal, Visual impairment, Vomiting, White blood cell count decreased, White blood cell count normal, White blood cells urine positive, X-ray normal, Mental status changes, Rheumatoid factor negative, Abasia, Blood phosphorus decreased, Urine leukocyte esterase positive, Drug screen negative, Activities of daily living impaired, Parenteral nutrition, Eosinophil percentage increased, Neutrophil percentage decreased, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Central venous catheterisation, CSF white blood cell count increased, Gaze palsy, Urine ketone body present, Urine output decreased, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Angiogram normal, Psychotic disorder, Herpes simplex serology negative, Gastrointestinal sounds abnormal, Oropharyngeal pain, West Nile virus test negative, Immunoglobulin therapy, Clostridium test negative, Borrelia test negative, Parvovirus B19 test, Enterovirus test negative, Streptococcus test negative, Computerised tomogram head normal, Encephalitis autoimmune, Anti-NMDA antibody positive, Nuclear magnetic resonance imaging spinal abnormal

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 58     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: No she was a healthy kid The following information was obtained through follow-up and/or provided by the government. Bug bite around time of vaccination.
Preexisting Conditions: None The following information was obtained through follow-up and/or provided by the government. 2nd hand smoke exposure in home. Family hx MS, seizures.
Diagnostic Lab Data: Anti-NMDA receptor encephalitis she can''t rememeber how to spell, math. She can''t get some of her words out she has seizures and she had Guillain Barre syndrome. The following information was obtained through follow-up and/or provided by the government. 6/19 & 7/9/2013 lab/diagnostic records received for DOS 8/30-9/27/2012. X-ray abdomen/rt clavicle/C-spine, CT head, ECG, visual evoked potentials, MRA neck WNL. Strep, throat/CSF cx, pregnancy test, drug screen, ASO, enterovirus, HSV, ANA, RF, WNV, encephalitis, Lyme (-). UA: hazy, ketones $g80 (H). Blood: WBC 8.1 K/mm3 (N), neutros 74.9% (H), lymphs 17.4% (L), HCO3 17.3 mEq/L (L), Ca 8.8 mg/dL (L), CO2 16-28.8 mmol/L (L-H), K 3.2 mmol/L (L), bili 2.5 mg/dL (H), BUN <5 mg/dL (L), creatinin
CDC 'Split Type':

Write-up:Vomiting dizzy fainting jerking on right side in pain then she couldn''t hardly speak acting crazy at times couldnt walk or feed herself. She got anti-NMDA receptor encephalitis from it and seizures and she Guillain Barre syndrome. The following information was obtained through follow-up and/or provided by the government. 6/19/2013 ER records received for DOS 8/30/2012. D/c Dx''s: 1) syncopal episode; 2) vomiting; 3) mild dehydration. Pt c/o 2 day hx nausea, vomiting, abdominal pain, fever, syncopal episode w/ LOC/fall/head trauma, pain to side of face (from fall), neck pain. Passed out multiple times. PE: flushed skin, tacky mucous membranes, tenderness C3-5/lt forehead/lt cheek, diffuse abdominal tenderness to lower quadrants. Syncopal episode probably from vomiting & dehydration. Tx''t: IVF, antiemetic. Condition improved, pt d/c''d home w/ Rx, care, & f/u instructions. 6/19/2013 hospital records received for DOS 9/1-2/2012. D/c Dx''s: 1) dehydration; 2) gastritis. Returned w/ continued vomiting, sore throat, headaches, decreased urinary output, no appetite, confusion. PE: abdominal tenderness, slow to answer questions, mucous membranes tacky, decreased bowel sounds. Admitted. Tx''t: IVF. Pt d/c''d home in excellent condition w/ care & f/u instructions. 6/19/2013 hospital records received for DOS 9/4-15/2012. D/c Dx: MS. Pt c/o head/eye/back/rt breast pain, persistent tingling/numbness RUE, intermittent confusion, screaming, memory impairment, diarrhea, episodes of slurring & difficulty w/ speech, more quiet & w/drawn, difficulty swallowing. EMS transported pt to hospital. PE: confusion resolved, slow deliberate speech, rt side weakness, periods of poor communication, T8 tenderness, thigh twitching. Tx''t: IVF, high dose steroids, PT, OT, ST. Developed confusion, agitation, seeing lights, exotropia. Signs of steroid psychosis after 3 days - dose reduced. Pt on pureed diet due to inadequate chewing, no signs of aspiration. Pt d/c''d home in good condition w/ PT, OT, ST, care, & f/u instructions. 7/9/2013 neuro consultant records received for DOS 9/17-11/2/2012. D/c Dx: anti-NMDA encephalitis. Pt presents w/ progression of above symptoms, falls, rt sided gaze, rhythmic movements, enuresis, inability to walk & talk, abnormal behavior (pulling hair, laughing hysterically for no reason), difficulty eating solids. Presumptive Dx of MS vs ADEM. PE: tachycardia, dry lips, bladder distension, frequent intermittent non-rhythmic worm-like undulating movements of rt fingers, rt corner of mouth intermittently pulled up, reflexes more brisk in LE, difficult to assess neuro status due to pt non compliance, increased tone to LE. Admitted. Tx''t: ICU, central line, plasmapheresis, TPN, NG tube feedings, Rituximab, IVIG, anticonvulsants, PT, OT, ST. Complications: fluctuating mental status, uncontrolled agitation, deranged sleep, hallucinations, urinary retention, Pseudomonas UTI, rash. Condition improving, d/c''d to inpt rehab 11/2-12/7/2012. Pt continued improving in rehab. D/c''d home w/ care & f/u instructions. 7/9/2013 rehab & neuro consultant records received for DOS 1/30/2013. Dx''s: 1) NMDA receptor encephalitis; 2) symptomatic localization-related epilepsy. Pt seen in f/u to hospitalization. Pt having complex partial seizures (RUE flexes up, head to rt, LE tonic extension). PE: DTRs 3 @ rt patella, 2@ lt patella, lt hip flexor strength 5-, RLE steppage gait. Seizures under suboptimal control.


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