Received May 26, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| RSV | RSV (MRESVIA) | MODERNA | 1 | — | IM / LA |
MULTIPLE SCLEROSIS, RELAPSING REMITTING; This 41-year-old, male subject (US0010042) was participating in A Study and experienced serious (life-threatning, disability) adverse event of special interest (AESI) of multiple sclerosis, relapsing remitting (Relapsing-remitting multiple sclerosis). The subject's medical history, as provided by the investigator, included coronary artery disease (small vessel), 2 coronary artery stents placed, diabetes mellitus (type II) (without complication, without long-term current use of insulin), hypertension, vertigo (some episodes), cardiac chest pain, gall bladder removal and appendix removal. Prior to enrollment, the subject also had episodes of headaches which were attributed to migraines with aura (intractable chronic migraine with status migrainosus), history of hyperlipidemia (HLD) (unspecified hyperlipidemia type), elevated liver enzymes, hepatic steatosis, class 2 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 35.0 to 35.9 in adult, snoring, right sided sciatica, lumbar disc herniation, hepatomegaly and vitamin D deficiency. The subject had reported family history of headaches in the following relatives: mother ("told the subject that when she worked in a factory she had migraines"); mother had giant cell arthritis and lost vision; otherwise, he denied family history of autoimmune disease. Concomitant medications reported included metformin, acetylsalicylic acid, atorvastatin, carvedilol, losartan, ranolazine, ticagrelor, nitroglycerin, ezetimibe, isosorbide mononitrate, meclozine, nortriptyline, lidocaine, chlorzoxazone, paracetamol, butalbital/caffeine/paracetamol, topiramate and rimegepant. Prior to event onset, the subject received blinded first dose of mRNA-1345 30ug vs mRNA-1345 50ug, 1 dosage form (one time dose), intramuscularly in the left arm for RSV immunization on 05-FEB-2024, approximately 4 months 12 days before event onset. The subject's last dose of study drug prior to event onset was on the same day. At the time of study drug administration, the subject was deemed clinically stable and was not having any symptoms. It was reported that the subject was seeing neurologist for episodes of headaches (history of migraines) and vertigo. Vertigo was present for several years, but he had an episode on 03-JAN-2024 which resolved with meclozine. On 13-APR-2024, the subject developed what was thought to be sciatic pain that radiated down his legs and caused muscle weakness. On 15-APR-2024, the subject visited the emergency room (ER) due to acute low back pain, unspecified back pain laterality, unspecified whether sciatica was present (primary diagnosis (Dx)); however was not hospitalized (as the discharge note was from the same day as the examination, and discharge disposition included emergency department (ED) only). The subject reported a slight radiation of pain down into the right leg. He had experienced sciatic pain in the past and stated that the symptoms started two weeks ago, initially improved, but then returned. He denied any direct trauma to the back and also denied urinary or bowel incontinence or retention, saddle anesthesia, and intravenous (IV) drug abuse; no red flag symptoms. Additionally, he reported that he had been carrying some five-gallon jugs of water, which might have triggered the symptoms. The differential diagnosis included no back pain, sciatic pain, and low concern for spinal cord pathology. The plan was to try a muscle relaxant and analgesics and then reevaluate. The subject's pain somewhat improved, and he was comfortable with discharge. On 07-MAY-2024, magnetic resonance imaging (MRI) angiogram head and neck without IV contrast was performed due to sudden thunderclap headache, with following results: normal MRA of the neck, less than 50% stenosis of the internal carotid arteries bilaterally, widely patent vertebral arteries; normal MRA brain. On 09-MAY-2024, MRI brain with and without contrast was performed, which showed: abnormal study; although there were only 3 foci of abnormal fluid-attenuated inversion recovery (FLAIR) signal, 2 of them were in strategic locations frequently observed in patients with central demyelination (two periventricular, one of which was infratentorial, lesions and cord lesions). If the subject had symptoms of multiple sclerosis, additional investigation could be warranted. On 14-MAY-2024, the subject was seen by neurologist; his headaches were daily at that time and sciatica was getting better. On 17-MAY-2024, following laboratory tests were performed: alanine aminotransferase (ALT): 59; aspartate aminotransferase (AST): normal; glycated hemoglobin (A1c): 7.6. Additionally, following laboratory tests were performed: aquaporin-4 antibody (AQP-4): negative; vitamin D: low at 10; copper: 107; syphilis: negative; Lyme: negative; thyroid-stimulating hormone (TSH): 1.64; vitamin B12: 337; methylmalonic acid: 0.12; erythrocyte sedimentation rate (ESR): 5; C-reactive protein (CRP): high at 8. On 24-MAY-2024, oligoclonal banding was positive. On 28-MAY-2024, lumbar puncture (opening pressure 13 cm) was performed. Electronic medical record (EMR) notes included information regarding testing on the cerebrospinal fluid (CSF), which showed demyelinating lesions along with 11 oligoclonal bands, which met the criteria for multiple sclerosis. Obtained CSF was tested for: CSF IgG index: 1.56 (H) (reference range: less than or equal to 0.85); immunoglobulin G, CSF: 7.7 mg/dL (less than or equal to 8.1); albumin, CSF: 28.0 mg/dL (H) (less than or equal to 27.0); CSF IgG/albumin ratio: 0.28 (H) (less than or equal to 0.21); CSF IgG synthesis rate: 26.00 (H) mg/24 h (less than or equal to 12); immunoglobulin G, serum: 768 mg/dL (767-1590); albumin, serum: 4200 mg/dL (3500 - 5000); IgG/albumin ratio, S: 0.18 (less than or equal to 0.40); oligoclonal banding: oligoclonal bands, CSF: 13 bands; oligoclonal bands, serum: 2 bands; oligoclonal bands intrathecal (INTR): 11 (alert (A)) (less than 2 bands); comment: the oligoclonal band assay detected 2 or more unique IgG bands in the CSF, which was a positive result; protein, CSF: 48 mg/dL (H) (15-40); glucose, CSF: 102 mg/dL (H) (40-70); Kappa free light chains, CSF: 1.85 mg/dL high (less than 0.1000) CSF was also tested for fluid/tissue culture and Gram stain, which showed no growth, less than 10 white blood cells (WBC) per low power field, no organisms seen. CSF spinal had no color, clear appearance; red blood cell (RBC): in fluid: 4 per ul (H) (0-0). On 03-JUN-2024, because of chronic complaints, the subject visited his neurologist as an outpatient, who did a work-up for multiple sclerosis (MS): MRI thoracic spine with and without contrast was performed in a context of history of demyelinating disease, which showed several small foci of abnormal signal in the cord as T7-T8 and T11 suggestive of demyelinating lesions. No abnormal enhancement; multilevel spondylosis. Lumbar and cervical spine MRI showed demyelinating lesions. On 12-JUN-2024, magnetic resonance Imaging (MRI) of the cervical spine was performed, which showed equivocal signal abnormality in the right spinal cord at the C6-C7 level, left disc osteophyte at C6-C7, with left ventrolateral impingement on the subarachnoid space, mild disc desiccation with uncovertebral joint changes and left greater than right foraminal encroachment at C5-C, no abnormal enhancement detected. Lumbar and cervical spine MRI showed demyelinating lesions. On 18-JUN-2024, the subject was seen by a neurologist for unity neurology follow-up visit for chief complaint: MRI/LP result, dizziness, headache, RLE numbness/weakness episodes, sciatica and low back pain. During that visit it was discussed, that his MRI and lumbar puncture (LP) results were consistent with (c/w) MS; the subject was diagnosed with multiple sclerosis, relapsing remitting. Treatment with ofatumumab was considered at that time. Type and prognosis were unknown. The subject was offered a second opinion at another MS medical center. He reported that his migraines were less frequent and he still had vertigo and daily headaches, but they were less severe. His RLE sciatica was resolved. Dosage of topiramate was increased to 75 mg. At that time, headaches were slowly improving, he had 3 migraines in the past months, however he was still getting near daily headaches, less severe. He was trying to walk but he would get vertigo and his shoulder bothered him. He was getting vertigo mainly with heavy physical exertion. He had to clean an office at work and this triggered vertigo. His right leg sciatica was resolved but he did have low back pain sometimes. Lab results were reviewed and his vitamin D level was low. Additional labs would be checked to screen for underlying infections, immune deficiency, underlying autoimmune disease or vitamin deficiencies prior to initiation of MS disease. MS disease modifying therapy was discussed. Given the presence of cord lesions, a higher potency agent was favored. Additionally, he also felt that he would struggle with near-daily self-injections but preferred an infrequent (monthly) injection. He also had mild liver dysfunction on lab results, so we wanted to avoid DMTs with a risk of hepatotoxicity (glatiramer acetate, dimethyl fumarate, teriflunomide, and cladribine were avoided). Ofatumumab was planned, which was administered as a home subcutaneous injection with three weekly starter doses followed by a once-monthly injection. Potential side effects were discussed. The subject was advised to get age-appropriate cancer screenings and all relevant immunizations prior to starting DMTs. Second opinion as MS center was discussed. The subject was counseled on typical MS symptoms and instructed to call if he experienced any new neurological symptoms. He would continue vitamin D supplements with rechecking his vitamin D level in several months. A repeat MRI brain scan would be due in approximately 6 months to monitor his MS. He would increase topiramate to 75 mg/day for headache prevention. On 19-JUN-2025, following lab tests were performed: vitamin B6, plasma was 21.7 nmol/L (20.0 - 125.0); folate: 16.1 ng/ml (less than 5.4); rheumatoid factor: 3.9 IU/mL (0.1-13.9); anti-Sjogren syndrome (SSA) AB: negative; anti-SSB AB: negative; anti-neutrophil cytoplasmic antibodies (ANCA): less than 1:20 (less than 1:20; antinuclear antibody (ANA) screen: negative; John Cunningham virus (JCV) antibody: negative; hepatitis A AB, IgM: negative; hepatitis B surf AG: negative; hepatitis B core AB, IgM: negative; hepatitis C AB: negative; varicella zoster immune status: 2.8 AI (equal to or more than 1.1 is positive: indicated presence of detectable antibody); human immunodeficiency virus (HIV) 1 and 2: nonreactive. As of 24-JUN-2024, the subject was stable without any new symptoms. Because of spinal cord lesions, the subject would likely start multiple sclerosis (MS) therapy. On 15-JUL-2024, the subject had an appointment at the Multiple Sclerosis (MS) Center to receive a second opinion, and the principal neurologic diagnosis was relapsing and remitting, multiple sclerosis (RRMS), treated with subcutaneous ofatumumab, and ongoing physical therapy. Given his young age, cord involvement, and brainstem involvement, physician agreed with the plan to start highly potent disease-modifying therapy (DMT). He briefly discussed with the subject the alternatives of ocrelizumab and natalizumab, but he felt comfortable with self-injections of ofatumumab. He was following up with another neurologist, but the physician was "happy to manage treatment with ofatumumab if desired". He was still updating vaccinations and was advised to wait 4 weeks after a live vaccine before starting injections (measles, mumps, and rubella (MMR) was scheduled for the next day). Symptomatically, his migraine with aura was being managed. His episodes last winter were atypical, but they could have represented a paroxysmal cerebellar event due to his middle cerebellar peduncle (MCP) lesion. If these were to recur, trial of carbamazepine could be considered. Plan included: disease-modifying therapy: agreed with plan for ofatumumab, advised waiting 4 weeks after MMR; pre-treated first dose with 50 mg prednisone, prescription was sent; managed MS care but remained available for periodic consultation; symptomatic therapy: continued migraine management and considered carbamazepine if paroxysmal episodes recurred; imaging: planned MRI 6 months after DMT initiation, then annual surveillance imaging; laboratory studies: ordered lymphocyte subsets, complete blood count (CBC) with differential, comprehensive metabolic panel (CMP), and immunoglobulins while on ofatumumab, planned for 3 months after initiation, then every 6 months if stable; follow-up: scheduled follow-up in 6 months or as needed (PRN) if the patient preferred to continue with his primary neurologist. The subject reached out to the center to clarify that he did have childhood vaccines despite waning titers. Hepatitis B booster and MMR vaccine were recommended but waiting 4 weeks after MMR before ofatumumab; the subject was also getting Varicella zoster vaccine. On 06-AUG-2024, the subject had a follow-up neurology visit. Chief complaint: multiple sclerosis (MS), dizziness, headache, right lower extremity (RLE) numbness/weakness episodes, sciatica, low back pain, cognitive symptoms, fatigue. Second opinion note from MS medical center was reviewed. The subject was pending treatment with ofatumumab, which was delayed likely due to recent live virus vaccine. MS center recommended use of prednisone as a pre-treatment with his first dose. Laboratory tests would be ordered 3 months after initiation of ofatumumab. The subject would be due for another MRI brain and computerized tomography (CT) spine in December 2024. At the time of the follow-up consultation, the subject continued to have frequent headaches, but he felt that heat was a trigger. He was asked to keep a headache diary. Topiramate dosage was increased to 100 mg and he was prescribed butalbital/acetaminophen/caffeine for more severe headaches and rimegepant for milder ones. It was suspected that his fatigue and cognitive symptoms were MS related. He felt that they predated topiramate. Neuropsychological testing was requested as the cognitive symptoms were interfering with his work. He had ongoing RLE weakness, which was intermittent; suspected due to a lumbar herniated disc. It was not severe enough to require surgical referral at that time. Follow-up was scheduled in 2 months. On an unknown day in September 2024, the subject started treatment with ofatumumab. He had a constant runny nose all fall but did not experience a serious infection. He had seasonal allergies most falls. He experienced nausea after injections if he took them on a full stomach. On an unknown day in December 2024, following laboratory tests were performed: complete blood count (CBC) (no differential): normal; comprehensive metabolic panel (CMP): normal; immunoglobulins (IgG/A/M): normal; CD19: 0. On 16-DEC-2024, the subject had a follow-up visit at MS center. The subject's vision had improved since the last visit, and he was less photophobic. He always felt like he had a flipper on his right leg, which was not new. He felt off balance when going through revolving doors and took things slowly on the stairs. He experienced muscle spasms. He described a sudden, brief chill down the spine along with a shake, which occurred once per day. He had muscle twitching in the left leg. His left leg jerked, and these happened every other day. He did not think he wanted a medication. His migraines had improved. He used rimegepant and butalbital/caffeine/paracetamol as needed (prn). He had multiple stents in the left anterior descending (LAD) artery and other arteries with 80% occlusion. He followed closely with cardiology. His brother had recently died of a myocardial infarction (MI) at the age of 44. He was working on his health through weight loss. Cardiology had advised him to avoid exercise in cold air, which was limiting for him during the winter since he liked to walk outside. It was assessed, that the subject was doing well that day, but would benefit from physical therapy (PT) for balance training. He was pleased with ofatumumab treatment and his labs were appropriate. He wanted to continue following up with both treating centers. The subject was told that MS center team was happy to manage his MS medications and care, and they could also manage his migraine treatment (apart from injections) if he wanted to consolidate in the future. Plan included: continued ofatumumab, managed by primary neurologist, center was available for MS care management or periodic consultations; symptomatic therapy: continued migraine management and considered carbamazepine if paroxysmal episodes recurred.; imaging: planned for MRI 6 months after DMT initiation, then annual surveillance imaging; laboratory studies: monitored lymphocyte subsets, complete blood count (CBC) with differential, comprehensive metabolic panel (CMP), and immunoglobulins every 6 months while on ofatumumab; follow-up: scheduled in 6 months or PRN if the subject preferred to continue with his primary neurologist. On 30-JAN-2026, the subject completed the study. Action taken with mRNA-1345 30ug vs mRNA-1345 50ug in response to the event was reported as not applicable. The outcome of event, multiple sclerosis, relapsing remitting, was reported as resolved with sequelae on 15-JUL-2024. Sequelae was reported as relapsing-remitting, treated with ofatumumab and ongoing physical therapy. The investigator assessed the causality of the event, multiple sclerosis, relapsing remitting, as not related to study drug. Prior to enrollment. He had had episodes of headaches which were attributed to migraines, and he had some episodes of vertigo. At the time of vaccination, he was deemed clinically stable and was not having any symptoms. He was vaccinated in February and then developed leg pain in April. It was at that point; he saw a neurologist as an outpatient and they did a work up for MS now considering all his symptoms going back in time and including the headaches and the vertigo. It was at that point he was diagnosed with MS. I felt it the MS was not related to the vaccine because there was a high suspicion that the symptoms prior to vaccination were undiagnosed MS. In addition, no risk factors of multiple sclerosis, relapsing remitting were known. Follow-up received on 27-SEP-2024 included added risk factors details. Follow-up received on 26-FEB-2025 included updated event term (from "multiple sclerosis" to "multiple sclerosis, relapsing-remitting."), event end date and outcome (from "not recovered/not resolved" to "recovered/resolved with sequelae"), additions to concomitant medications, and further details regarding the event. Follow-up received on 26-FEB-2025 included event verbatim updated (previously multiple sclerosis, relapsing-remitting) and course of the event updated. Follow-up received on 07-MAR-2025 included deleted life-threatening seriousness criterion, details on the course of the event, subject's medical history and laboratory data. Follow-up received on 02-MAY-2025 included updated SAE coding (LLT changed). Follow-up received on 18-MAY-2026 included added AESI criterion, updated seriousness criteria (life-threatening), diagnostic test details. Additionally, subject completed the study. Medical summary: This case involves a 41-year-old male subject with a relevant medical history of vertigo, episodes of headaches attributed to migraines with aura, right-sided sciatica, lumbar disc herniation, coronary artery disease, type II diabetes mellitus, and hypertension. Additionally, he had a family history of headaches, with his mother having migraines and giant cell arteritis leading to vision loss. The subject experienced an unexpected serious adverse event of relapsing-remitting multiple sclerosis, which occurred approximately 4.5 months after the most recent dose of the study vaccine. The company assessed the event as not related to the study drug, in agreement with the investigator, considering that the subject had a history of headaches attributed to migraines and episodes of vertigo that began before study vaccine administration. In April, after receiving the study vaccine, he developed leg pain, prompting him to consult a neurologist as an outpatient. A subsequent workup for multiple sclerosis was initiated, taking into account his history of symptoms, including headaches, vertigo, and the newly developed leg pain. Given the presence of neurological symptoms preceding study drug administration, the findings suggest a pre-existing condition rather than an event induced by the study vaccine.; Reporter's Comments: The investigator considered the event as not related to IP. Sponsor causality was assessed as not related to the study vaccine, considering that the subject had a history of headaches attributed to migraines and episodes of vertigo that began before study vaccine administration. In April, after receiving the study vaccine, he developed leg pain, prompting him to consult a neurologist as an outpatient. A subsequent workup for multiple sclerosis was initiated, taking into account his history of symptoms, including headaches, vertigo, and the newly developed leg pain. Given the presence of neurological symptoms preceding study vaccine administration, the findings suggest a pre-existing condition rather than an event induced by the study vaccine.
Chest pain - cardiac; Coronary artery disease; Hypertension; Type II diabetes mellitus
Medical History/Concurrent Conditions: Appendectomy; Coronary stent placement (2 CORONARY ARTERY); Gallbladder removal; Vertigo
METFORMIN; ASPIRIN [ACETYLSALICYLIC ACID]; ATORVASTATIN; CARVEDILOL; LOSARTAN; RANOLAZINE; TICAGRELOR; NITROGLYCERIN; EZETIMIBE; ISOSORBIDE MONONITRATE; MECLIZINE [MECLOZINE]; NORTRIPTYLINE; LIDOCAINE; SKELAXINE; Butalbital;Caffeine;Paracet
Test Date: 20240517; Test Name: ALT; Result Unstructured Data: 59; Test Date: 20240528; Test Name: CSF IgG/albumin ratio; Result Unstructured Data: 0.28 (H) (norm high 0.21); Test Date: 20240528; Test Name: IgG/albumin ratio, S; Result Unstructured Data: 0.18 (norm high: 0.40); Test Date: 20240524; Test Name: Methylmalonic Acid; Result Unstructured Data: 0.12; Test Date: 20240507; Test Name: MRI angiogram head and neck without IV contrast; Result Unstructured Data: showed normal MRA of the neck, less than 50% stenosis of the internal carotid arteries bilaterally, widely patent vertebral arteries; normal MRA brain; Test Date: 20240524; Test Name: AQP-4; Test Result: Negative ; Test Date: 20240619; Test Name: anti-SSA AB; Test Result: Negative ; Test Date: 20240619; Test Name: anti-SSB AB; Test Result: Negative ; Test Date: 20240619; Test Name: JCV antibody; Test Result: Negative ; Test Date: 20240619; Test Name: ANCA; Result Unstructured Data: less than 1:20; Test Date: 20240619; Test Name: ANA screen; Test Result: Negative ; Test Date: 20240517; Test Name: AST; Result Unstructured Data: normal; Test Date: 20240528; Test Name: albumin, serum; Test Result: 4200 mg/dL; Test Date: 20240524; Test Name: copper; Result Unstructured Data: 107; Test Date: 20240619; Test Name: folate; Result Unstructured Data: Test Result:16.1 ng/mL;time: not reported; Test Date: 202412; Test Name: immunoglobulins IgA; Result Unstructured Data: normal; Test Date: 20240528; Test Name: CSF IgG synthesis rate; Result Unstructured Data: Test Result:26.00 mg/(24.h);High; Test Date: 20240528; Test Name: immunoglobulin G, serum; Test Result: 768 mg/dL; Test Date: 202412; Test Name: immunoglobulins IgG; Result Unstructured Data: normal; Test Date: 202412; Test Name: immunoglobulins IgM; Result Unstructured Data: normal; Test Date: 20240524; Test Name: TSH; Result Unstructured Data: 1.64; Test Name: BMI; Result Unstructured Data: 35.0 to 35.9 in adult; Test Date: 202412; Test Name: CD19; Result Unstructured Data: 0; Test Date: 20240524; Test Name: CRP; Result Unstructured Data: High at 8; Test Date: 20240528; Test Name: fluid/tissue culture CSF; Result Unstructured Data: no growth, no organisms seen; Test Date: 20240528; Test Name: glucose, CSF; Test Result: 102 mg/dL; Test Date: 20240528; Test Name: immunoglobulin G, CSF; Test Result: 7.7 mg/dL; Test Date: 20240528; Test Name: CSF IgG index; Result Unstructured Data: 1.56 (H) (norm high: 0.85); Test Date: 20240528; Test Name: albumin, CSF; Test Result: 28.0 mg/dL; Test Date: 20240528; Test Name: protein, CSF; Test Result: 48 mg/dL; Test Date: 20240528; Test Name: CSF RBC; Result Unstructured Data: Test Result:4 /uL;High; Test Date: 20240528; Test Name: CSF fluid; Result Unstructured Data: had no color, clear appearance; Test Date: 20240528; Test Name: CSF WBC; Result Unstructured Data: less than 10 per low power field; Test Date: 202412; Test Name: CBC (no differential); Result Unstructured Data: normal; Test Date: 20240517; Test Name: A1c; Result Unstructured Data: 7.6; Test Date: 20240619; Test Name: hepatitis A AB, IgM; Test Result: Negative ; Test Date: 20240619; Test Name: hepatitis B core AB, IgM; Test Result: Negative ; Test Date: 20240619; Test Name: hepatitis B surf AG; Test Result: Negative ; Test Date: 20240619; Test Name: hepatitis C AB; Test Result: Negative ; Test Date: 20240619; Test Name: HIV 1; Result Unstructured Data: nonreactive; Test Date: 20240619; Test Name: HIV 2; Result Unstructured Data: nonreactive; Test Date: 2024; Test Name: lab test; Result Unstructured Data: mild liver dysfunction; Test Date: 20240528; Test Name: Kappa free light chains, CSF; Test Result: 1.85 mg/dL; Test Date: 20240528; Test Name: lumbar puncture; Result Unstructured Data: demyelinating lesions; Test Date: 20240509; Test Name: MRI brain with and without contrast; Result Unstructured Data: abnormal study; although there were only 3 foci of abnormal fluid-attenuated inversion recovery (FLAIR) signal, 2 of them were in strategic locations frequently observed in patients with central demyelination (two periventricular, one of which was infratentorial, lesions and cord lesions); Test Date: 20240603; Test Name: magnetic resonance Imaging (MRI) of the cervical spine; Result Unstructured Data: demyelinating lesions; Test Date: 20240612; Test Name: magnetic resonance Imaging (MRI) of the cervical spine; Result Unstructured Data: equivocal signal abnormality in the right spinal cord at the C6-C7 level, left disc osteophyte at C6-C7, with left ventrolateral impingement on the subarachnoid space, mild disc desiccation with uncovertebral joint changes and left greater than right foraminal encroachment at C5-C, no abnormal enhancement detected;; Test Date: 20240612; Test Name: magnetic resonance Imaging (MRI) of the cervical spine; Result Unstructured Data: demyelinating lesions; Test Date: 20240603; Test Name: MRI lumbar spine; Result Unstructured Data: demyelinating lesions; Test Date: 20240612; Test Name: MRI lumbar spine; Result Unstructured Data: demyelinating lesions; Test Date: 2024; Test Name: MRI lumbar spine; Result Unstructured Data: did show a disc bulge; Test Date: 20240603; Test Name: MRI thoracic spine with and without contrast; Result Unstructured Data: several small foci of abnormal signal in the cord as T7-T8 and T11 suggestive of demyelinating lesions. No abnormal enhancement; multilevel spondylosis; Test Date: 202412; Test Name: CMP; Result Unstructured Data: normal; Test Date: 20240524; Test Name: Oligoclonal banding; Test Result: Positive ; Test Date: 20240528; Test Name: Oligoclonal banding; Test Result: Positive ; Test Date: 20240528; Test Name: oligoclonal bands intrathecal; Result Unstructured Data: 11 (A); the oligoclonal band assay detected 2 or more unique IgG bands in the CSF, which was a positive result; Test Date: 20240528; Test Name: oligoclonal bands, CSF; Result Unstructured Data: 13 oligoclonal bands; Test Date: 20240528; Test Name: oligoclonal bands, serum; Result Unstructured Data: 2 bands; Test Date: 20240524; Test Name: ESR; Result Unstructured Data: 5; Test Date: 20240619; Test Name: rheumatoid factor; Result Unstructured Data: Test Result:3.9 [iU]/mL;time: not reported; Test Date: 20240524; Test Name: syphilis; Test Result: Negative ; Test Date: 20240619; Test Name: varicella zoster immune status; Test Result: Positive ; Test Date: 20240524; Test Name: Lyme; Test Result: Negative ; Test Date: 20240524; Test Name: Vitamin B12; Result Unstructured Data: 337; Test Date: 20240619; Test Name: vitamin B6, plasma; Result Unstructured Data: Test Result:21.7 nmol/L;time: not reported; Test Date: 20240524; Test Name: Vitamin D; Result Unstructured Data: Low at 10