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This is VAERS ID 295507

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 295507 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Texas  
   Days after vaccination:14
Submitted: 2007-08-30
   Days after onset:23
Entered: 2007-11-05
   Days after submission:67
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Public
Symptoms: Ataxia, Azotaemia, Blood creatinine increased, Blood urea increased, Diplopia, Leukoencephalomyelitis, Muscular weakness, Nuclear magnetic resonance imaging brain abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Ocular motility disorders (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hyperlipidemia, abnormal LFT''s, acanthosis, overweight. PMH: Fx forearm, allergies, possible LFT abnormalities. NKDA.
Diagnostic Lab Data: MRI brain - abnormal findings in mid brain and base of brain; Increased BUN/CR. Labs and Diagnostics: MRI brain markedly abnormal findings involving midbrain and base of the brain. CT brain unremarkable. Renal US normal. Barium swallow with no penetration or aspiration. Admission CBC unremarkable. CMP with normal BUN and Creatinine with elevations beginning 8/16/07: BUN 20-57, Creatinine 1.8-3.8. Serum glucose elevations began 8/17/07. CSF with (+) RBCs with (+) oligoclonal bands. CSF MBP 7.76. CSF culture (-). No fungi in CSF. CSF HSV (-).Phytanic and Pristanic Acids WNL. Urine creatinine 52. UA with 1+ bacteria. UC (+) for Gram - bacillus and staph species. Tox screen (-).
CDC Split Type: TX0791

Write-up: Pt presented to the clinic on 8/13/07 with 1 week history of diplopia, ataxia, and weakness of extremities R$gL. Pt was admitted to hospital on 8/14 and dx with acute disseminated encephalomyelitis and azotemia. Pt was treated with a 5 day course of Solumedrol and Prednisone taper started with improvement in all sx''s except diplopia. 12/26/2007 MR received for DOS 8/14-24/2007. No formal D/C DX noted but following diagnostic studies DX of ADEM is proposed. Child presented to ER with 6 day hx of double vision, 4 day hx of unsteady gait, extremity weakness (R$gL) and abnormal eye movements noted by dad. Pt began running into things and falling while walking. Weakness, pain and unsteady gait have worsened. PE (+) for decreased strength upper & lower extremities, 1 beat clonus bilat, CN III palsy, R exotropia. Neurologic sequelae: Pt became more encephalopathic during admission (ataxia and III CN palsy) so transfered to PICU. Pt developed deteriorating renal function/azotemia which worsened after CT contrast. Txd with IV and po steroids. Discharged on day 10 in stable condition with aspiration precautions. 12/28/2007 Spoke with reporter who states only sequelae at this time is some occasional double vision when pt gets tired. Other sx such as ataxia, dysphagia and renal function are now resolved.

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