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This is VAERS ID 537510

Case Details

VAERS ID: 537510 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Michigan  
Vaccinated:2014-06-04
Onset:2014-06-18
   Days after vaccination:14
Submitted: 2014-07-23
   Days after onset:35
Entered: 2014-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 4735D / UNK RL / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J012212 / 1 LL / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4610BA / UNK RL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS EA2GE / UNK LL / IM

Administered by: Public       Purchased by: Private
Symptoms: Angiogram, Blindness, Bordetella test negative, Laboratory test normal, Nuclear magnetic resonance imaging, Optic neuritis, Treponema test negative
SMQs:, Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (broad), Ocular infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: MRI X 2, MRA, MULTIPLE LABS TESTS THAT RULED OUT ALL OTHER POSSIBILITIES (MS, BORTELLA, SYPHILLIS, ETC).
CDC Split Type:

Write-up: Bilateral vision loss. Bilateral optic neuritis. Initially dx 6/25/14. Remissions and exacerbations until the present time. Improvement with steroids.


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