Age: 1.25
Sex: M
Vaccine: MMR, PNC, VARCEL
Symptoms: Irritability, Musculoskeletal stiffness, Opisthotonus, Rhinorrhoea, Tremor
Clinical narrative: While the pt has had a runny nose on and off for the past few days, he has been otherwise well and the runny nose had caused no other symptoms. In fact, since his ear surgery on 4/13, we have had little to no problems with his health. He had a great check-up on 4/29 and the usual vaccinations. Included at that time was his 1st MMR injection. I was informed to watch for some fever and/or rash that may occur 10 days, post vax. Yesterday, I put him down for a nap at 14:00 and at approx. 17:00 or a few moments after, I heard him crying a strange cry. It sounded like something was caught in his throat. It was a very constrained, throaty and weak cry. When I went to his crib, he appeared to be having a seizure. This is what I observed: his entire body was rigid; his neck was flexed so that his head was pulled backwards; his arms were locked straight and out from the side of his body with at least 1 fist clenched (I don't recall examining his left hand), his legs were stiff and straight with knees locked, feet pointed down and his ankles pointed upward (much like a ballerina) but his toes wee flexed backwards. When I picked him up from the crib, his body remained in this position. He continued to cry the strange cry. He was not unconscious but neither was he awake or alert. His eyes were closed but would flicker open. He did not respond to any of my attempts to console him. Within a few minutes (approx. 5 min.) his legs were less rigid but his head remained in the flexed backward position. I placed him in the car and we drove to the ER. During the drive, (approx. 5 min. and no more than 10 min.), I was trying to watch him through my rear view mirror. His neck at times was still flexed. At other times, he would appear that his neck would flex. When we reached the ER, I explained fully all of the above observations to the ER personnel. I assumed the same information was being conveyed to you and/or your office. While in the ER, I recall that his neck was flexed, but I do not believe his neck remained in that position during the entire initial evaluation. I do remember pointing out at some point in time prior to the administration of the suppository that his neck was flexing again. His temperature was 101.8F rectally. The ER staff administered a Tylenol suppository and then let me hold him. By the time of the suppository, his limbs and head were shaking as if he had the chills. During this period of time, he was awake but was not responding to any attempt to console him and remained crying the strange cry. He was also sweating. At one point, he stopped crying and became more unresponsive. He was lying on his side on the gurney, staring blankly and would not respond to my voice or my face. He held one hand clenched and the other wide open. I could not change the positions of his fingers. He held his arms by his side with his elbow bent and his forearms forward (much like a robot). I could not change the position of his arms. I began to read a book to try to get him to respond and eventually I noticed some eye contact with the pages of the book. Then he would respond to my voice with eye contact. The ER staff gave him 2 injections, each containing Rocephin. I remember telling the nurse at that time, that he was still not responding like himself. He did scream when held down and given the injections. He was making some limited movements with his arms but was not trying to grab at the nurse or me while we were holding him down. He cried following the injections for some time. The ER staff gave him Motrin shortly after the injections. His arms and hands were still in the strange robot position described. By then his cry was somewhat more normal but still very throaty. Shortly after the Motrin and the injections, he began to be more alert and responsive. I was still concerned with the way he was holding his hands and arms. I tried to get him to play and grab at things with his arms. He could not. Eventually, he was better able to reach and eventually could grasp with his hands. By the time we left the ER, he was babbling and more awake and alert. I believe the ER discharged us at about 19:30. When we got home, he ate reasonably well and drank some juice. After dinner, however, we noticed he could not lift himself to walk. We stood him on his feet several times only to have him fall. We suspected this must have been a result of pain from the ER injections and, thus, put him to bed. We continued to dose him alternating Tylenol and Motrin throughout the night as directed by the ER. He arose this morning at approx. 08:00, very irritable and with somewhat of a continued throaty cry. Our concern heightened when we observed him continuing to struggle to walk. His efforts this morning were not as futile as last night, but it was clear he lacked his normal motor skills. We visited you first thing this morning at 09:00. My understanding from you after today's exam, is that he most likely had a febrile event, possibly a febrile seizure. Following our discussion, I am relieved that you believe the effects of this event will not be permanent. Since there is a possibility that this event was a reaction to the MMR vaccination, however, we should consult an allergists to examine any possible risks with further vaccinations. In other words, the MMR may have contributed to the fever which, in turn, led to the above-described activity. I understand you are going to file a report with CDC/FDA. Please include these observations with your report. Feel free to include this letter. I would also appreciate it if you would copy me with the material you send to them. Again, I write this so that you are clear as to everything I observed and that my understanding of the meaning of this event is correct. If I have misunderstood any of your advice or comments about this situation in any way, please let me know.