chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Asthenia, Carpal tunnel syndrome, Diagnostic procedure, Hypoaesthesia, Hypotonia
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Inappropriate schedule of drug administration, Joint swelling, Nerve injury, Oedema peripheral, Pain in extremity
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Pruritus, Sleep disorder, Surgery
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Asthenia, Carpal tunnel decompression, Carpal tunnel syndrome, Condition aggravated, Hypoaesthesia
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Hypotonia, Inappropriate schedule of drug administration, Insomnia, Joint swelling, Laboratory test abnormal
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Limb discomfort, Nerve conduction studies abnormal, Nerve injury, Oedema peripheral, Pain in extremity
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 59.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Pruritus
Clinical narrative: Information has been received from a registered nurse concerning a 59 year old female, who had been diagnosed with Shingles in January or February 2008, and had been placed on VALTREX for recent herpes zoster neuralgia in the back (area not specified) which was stopped 2 weeks prior to 19-MAR-2008.  The R.N. reported that the patient was taking LYRICA prior to 19-MAR-2008.  On 19-MAR-2008 the patient was vaccinated with a dose of ZOSTAVAX (Oka/Merck) (lot# 659763/1875U) in her left arm.  Concomitant therapy included CLARITIN-D, ADVIL, VIVELLE, DARVOCET-N and zolpidem tartrate.  One week after the vaccination, the patient experienced swollen and itchy left arm (also reported as injection site swelling).  On 29-MAR-2008, 10 days after the vaccination, the patient reported that she had swollen joints in her knees and hands.  On 02-APR-2008 the patient reported that she had trouble sleeping because her left arm was falling asleep and the pain in her left arm kept her awake.  On 11-APR-2008, it was reported that the patient visited a physician due to the pain in her left hand and arm because it had gotten so bad and numbness in her 3.5 left fingers.  The patient reported that the physician stated she had a carpal tunnel syndrome that was a reaction to the ZOSTAVAX (Oka/Merck) vaccination.  It was reported that the patient tried massage therapy, chiropractors, heat and ice-packs for 2 weeks and the patient reported that the pain was unbearable.  The patient stated that she lost strength in her left arm and lost muscle mass that was noticeable.  It was reported that the patient visited an Orthopedic surgeon on 09-MAY-2008.  The patient had seen another Orthopedic specialist and had a muscle and motor nerve testing which revealed severe nerve damage and muscle loss of the left hand.  The patient had carpal tunnel release surgery on 20-MAY-2008 and was hospitalized.  The doctor who performed the operation was concerned and thought that ZOSTAVAX (Oka/Merck) might be the cause of the "carpal tunnel problem".  Five weeks after the surgery the patient could not make a fist with her left fingers and had lost strength in her arm and hand.  The patient was concerned for her full recovery.  The patient stated to a pharmacist on 08-SEP-2008 that she was having problems now with her right arm and hand (problems unspecified).  The reporting nurse considered the patient's left arm swelling, joints swelling of hands and knees joints swelling, carpal tunnel syndrome, left arm itched, trouble in falling asleep for pain and problems with right arm and hand were considered to be disabling.  Additional information has been requested.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Blood product transfusion, CSF glucose increased, CSF myelin basic protein increased, CSF oligoclonal band absent, CSF protein increased
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: CSF white blood cell count increased, Catheter placement, Clonus, Depressed level of consciousness, Detrusor sphincter dyssynergia
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Endotracheal intubation, Hyperreflexia, Hypoaesthesia, Leukoencephalomyelitis, Muscular weakness
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain abnormal, Occupational therapy, Physiotherapy, Quadriplegia
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Red blood cells CSF positive, Sensory loss
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Bacterial culture negative, Blood product transfusion, CSF glucose abnormal, CSF myelin basic protein increased, CSF oligoclonal band absent
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: CSF protein increased, CSF test normal, CSF white blood cell count positive, Culture negative, Depressed level of consciousness
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Detrusor sphincter dyssynergia, Endotracheal intubation, Extubation, Hyperreflexia, Hypoaesthesia
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Leukoencephalomyelitis, Muscular weakness, Nuclear magnetic resonance imaging abnormal, Quadriplegia, Red blood cells CSF positive
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 20.0
Sex: M
Vaccine: SMALL, TYP, TYP
Symptoms: Sensory loss
Clinical narrative: This case was retrieved from the scientific literature on 15 September 2008.  A 20-year-old male military service member received a primary smallpox vaccination on an unknown date (manufacturer and lot number not provided).  Two days later, he received a typhoid inoculation (manufacturer and lot number not provided).  He was subsequently deployed overseas, and within seven days of his arrival he developed ascending, circumferential numbness in the lower extremities.  Within 24 hours his symptoms progressed, and physical examination revealed decreased sensation to the nipple line, significant lower extremity weakness, and symmetric hyperreflexia.  He was catheterized for 900 mL of urine, and required intubation within hours of presentation.  He had no history of recent illness, and no animal or insect bites.  An MRI performed 48 hours after presentation showed multifocal diffuse T2 hyperintensity throughout the brain and spinal cord.  Cerebrospinal fluid (CSF) contained 27 leukocytes, 40 erythrocytes, protein of 113, and glucose of 80.  Myelin basic protein was elevated at 6.0, and oligoclonal bands were absent.  Additional testing of the CSF was negative, including Lyme, varicella zoster, herpes simplex one and two, Epstein-Barr, Eastern equine encephalitis, Saint Louis encephalitis, Lacrosse, cytomegalovirus, and HIV.  Cultures for bacteria and fungus were also negative.  The patient was diagnosed with Acute disseminated encephalomyelitis (ADEM).  He was initially started on high dose intravenous SOLU-MEDROL, but remained quadriplegic and obtunded after five days of therapy.  Seven days after symptom onset he was started on 5% intravenous immunoglobulin (IVIG) at 2g/kg, infused over eight hours.  Steroids were tapered.  Within 12 hours of initiating therapy with IVIG, the patient was able to raise his right arm.  Within 48 hours, he regained spontaneous eye opening, and could respond appropriately by nodding yes or no.  He was extubated without difficulty.  Nineteen days after receiving IVIG he had regained fine motor control of his upper extremities.  After two weeks his recovery plateaued, and he was administered two additional IVIG boluses of 150g with little effect.  He eventually regained strength and control of his upper extremities, and was able to move his right lower extremity with gravity.  His left lower extremity remained significantly impaired.  Following one year of physical and occupational therapy, he was able to walk over 300 yards and climb six flights of stairs.  He showed no cognitive impairment.  Detrusor sphincter dyssynergia persisted, and the patient still required anticholinergic therapy and daily catheterization.
Age: 60.0
Sex: M
Vaccine: FLU3
Symptoms: Increased upper airway secretion, Mobility decreased, Musculoskeletal stiffness
Clinical narrative: Inability to use my arms, legs properly - incredible muscular stiffness throughout my body; dry cough; phelgm in my lungs, lost my voice  9/23/08 Reviewed PCP medical record of 9/22/08. FINAL DX: URI, doubt adverse effect of flu shot Record reveals patient experienced muscle stiffness & pain, tired, hoarse voice, wet cough, scratchy throat.  Sick contact at work w/similar symptoms. Symptomatic tx.