Age: 15.0
Sex: F
Vaccine: HEPA, HPV4, MNQ, HEPA, HPVX, MNQ, HEPA, HPV4, MNQ
Symptoms: Chest pain, Culture negative, Culture stool negative, Cytomegalovirus antibody positive, Double stranded DNA antibody
Clinical narrative: This case was received from Centers for Disease Control and Prevention (reference numbers VAERS #279082/279107) on 20 July 2007.  This case was initially reported by a physician in the USA.  A 14 year old female patient, received on 28 March 2007 first dose of Menactra (lot #02141AA), intramuscular, into the left arm, first dose of Gardasil (Merck lot #01884), intramuscular into the right arm and first dose of Havrix (GSK lot #AHAVB148AA).  On 28 April 2007, a month after administration of the vaccines, the patient developed Guillain-Barr Syndrome (GBS) with left Bells Palsy, which progressed over the next 2 weeks.  The patient was seen in the emergency room and was admitted to the hospital for 6 days - from 16 May 2007 until 21 May 2007, (reported as 5 days) with complaints of numbness and tingling of the dorsom of her hands (right hand tingling presented on 10 May 2007) progressing up her forearm.  Also complained numbness and tingling of the feet (right foot pain and numbness presented on 14 May 2007) progressing up her leg; Evaluated as Paresthesias of bilateral lower extremity and hands and arms in glove and stocking forearms.  The patient experienced weakness of left corner of her mouth: cranial nerves II through XII intact with exception of mild left facial droop, but no other cranial nerve findings, and no weakness of extremities - strength and motor intact.  Numbness stated in the right hand approximately one month after vaccination.  She did have absent LE DTR's (0) (lower extremity Deep Tendon Reflexes) and 2+ UE DTR's (upper extremity Deep Tendon Reflexes).  The patient was treated with IVIG 500mg/kg/day for 3 days.  Her signs and symptoms did not progress and neuron exam was unchanged at the day of discharge with slight improvement daily.  The patient's working diagnosis was Landy-Guillain-Barre Miller-Fisher variant.  It was also reported that on 05 June 2007, records from a facility indicated that the patient was diagnosed with GBS, left Bells Palsy and Paresthesis.  Relevant laboratory and diagnostics included: CT brain- Within Normal Limits (NOL); MRI scans of brain and spine = WNL; CXR - NML; Hemogram, Metabolic panel, CRP, ESR, T4, TSH, UA, B12, Folate - all WNL; Hepatitis panel - negative except for HBaAb of 28, indicating immunity.  ESV panel positive for IgG and NAg, but negative for IgM and EAg.  CMV panel positive for IgG but negative for IgM.  ANA equivocal at 0.92; DSDNA negative; HSV igG and IgM negative; CSF normal with 1 WBC, 19 RBC, Protein 37; HSV-PCR lyme-PCR, Alpha Toco, Gamma Toco, Enterovirus-PCR, VZV-PCR-all negative; Stool culture negative for Salmonella and Shigella, but Campylobacter results were pending.  CSF culture-negative, CSF viral culture pending but negative thus far; HCG-negative.  The patient's pre-existing conditions included: persistent left sided chest pain of unclear origin since 19 January 2007 and a speckled positive ANA 1:160 since 22 January 2007.  "Cleared by cardiology and was to be seen by rheumatology."  Illness at vaccination time included: recurring chest pain and multiple nevi which was evaluated by a dermatologist.  The patient was living in woods and a family pet with ticks.  Patient's outcome was unknown.  Follow-up information received on 01-October 2007 from the Centers for Disease Control and Prevention.  It was reported that the patient recovered.  The date of recovery was not provided.