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This is VAERS ID 537510

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2014

537510
VAERS Form:
Age:11.0
Gender:Female
Location:Michigan
Vaccinated:2014-06-04
Onset:2014-06-18
Submitted:2014-07-23
Entered:2014-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 4735D / - RL / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J012212 / 0 LL / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR U4610BA / - RL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS EA2GE / - LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Blindness, Nuclear magnetic resonance imaging, Optic neuritis, Laboratory test normal, Angiogram, Bordetella test negative, Treponema test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 10/14/2014

537510 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Michigan
Vaccinated:2014-06-04
Onset:2014-06-18
Submitted:2014-07-23
Entered:2014-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 4735D / - RL / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J012212 / 0 LL / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR U4610BA / - RL / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4610BA / - RL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS EA2GE / - LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Blindness, Nuclear magnetic resonance imaging, Optic neuritis, Laboratory test normal, Angiogram, Bordetella test negative, Treponema test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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) 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.


Changed on 7/14/2015

537510 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Michigan
Vaccinated:2014-06-04
Onset:2014-06-18
Submitted:2014-07-23
Entered:2014-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 4735D / - RL / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J012212 / 0 LL / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4610BA / - RL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS EA2GE / - LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Acute sinusitis, Blindness, Discomfort, Eye pain, Mass, Nuclear magnetic resonance imaging, Optic neuritis, Laboratory test normal, Angiogram, Bordetella test negative, Treponema test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2015

537510 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Michigan
Vaccinated:2014-06-04
Onset:2014-06-18
Submitted:2014-07-23
Entered:2014-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 4735D / - RL / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J012212 / 0 LL / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4610BA / - RL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS EA2GE / - LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Acute sinusitis, Blindness, Discomfort, Eye pain, Mass, Nuclear magnetic resonance imaging, Optic neuritis, Laboratory test normal, Angiogram, Bordetella test negative, Treponema test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2017

537510 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Michigan
Vaccinated:2014-06-04
Onset:2014-06-18
Submitted:2014-07-23
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 / 0 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: Blindness, Nuclear magnetic resonance imaging, Optic neuritis, Laboratory test normal, Angiogram, Bordetella test negative, Treponema test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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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