Age: 17.0
Sex: F
Vaccine: MNQ, MNQ
Symptoms: Syncope, Vaccination complication, Varicocele, Visual impairment
Clinical narrative: early varicocele; vaccine adverse reaction; visual impairment- abnormal vision; skin striae-minimal on legs, striae atrophicae; patient felt dizzy immediately after receiving vaccine; Syncope for approximately 1 minute; Initial information received on 14-Aug-2020 regarding an unsolicited valid serious case from a nurse.  This case is linked to cases 2020SA202835 and 2020SA202863 (same reporter).  This case involves a 17 years old female patient who had syncope for approximately 1 minute, visual impairment- abnormal vision (visual impairment), skin striae-minimal on legs, striae atrophicae (skin striae), felt dizzy immediately after receiving vaccine (dizziness) and vaccine adverse reaction (vaccination complication), early varicocele (varicocele) while she received vaccine MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE [MENACTRA].  The patient's past vaccinations included TUBERCULIN P.P.D.(MANTOUX) [TB (PPD)] on 10-Sep-2012 with read/ interpret, 07-Sep-2012,  influenza vaccine on 18-Feb-2013 (intranasal route), influenza vaccine on 05-Mar-2014 at 3 years (intramuscular route), meningococcal polysaccharide A/C/W on 06-JUN-2014 with intramuscular; DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS [Tdap vaccine] on 06-Jun-2014 at 7 years via intramuscular route; HPV VACCINE VLP RL1 4V (YEAST) [HPV quadrivalent] on 22-Apr-2015 at 12 years [0.5 ml , intramuscularly in the left arm (batch number K009482 and expiration date  03-Mar-2017)], HPV VACCINE VLP RL1 4V (YEAST) on 23-Jun-2015 at 12 years [0.5 ml , intramuscularly in the left arm (batch number K011532 and expiration date  08-April-2017)], influenza quadrivalent on 13-Nov-2015 at 12 years [0.5 ml , intramuscularly in the left Deltoid (batch number 3L7MZ and expiration date  30-Jun-2016)], HPV VACCINE VLP RL1 9V (YEAST) (HPV9) on 13-Nov-2015 at 12 years [0.5 ml , intramuscularly in the right deltoid (batch number L017407 and expiration date 15-Aug-2017)] and quadrivalent influenza vaccine (influenza quadrivalent) on 26-Jan-2018 at 14 years [0.5 ml , intramuscularly in the left arm (batch number BF7CA and expiration date  30-Jun-2018)] all for prophylactic vaccination.  Surgical history was not reviewed (last reviewed on 26-Jan-2018), Gynecological history was not reviewed (last reviewed-26-Jan-2018).Menarche was started at the age of 13 years, Date of Last menstrual period:11-Jan-2018, menses occurred monthly and the duration of flow was 7 days and was light. Obstetric history was not reviewed (last reviewed on 26-Jan-2018) and past medical history was not reviewed (last reviewed on 26-Jan-2018).  Social history was not reviewed (last reviewed on 26-Jan-2018): barrier noted and language barrier were reported as no. language spoken and understood at home was English. The patient has not been in the relationship where she was physically hurt, threatened or made to feel afraid. The patient was never a smoker (most recent tobacco screening was done on 26-Jam-2018).The patient wear glasses (H54.7: unspecified visual loss).  No known drug allergies were reported. Patient had no new allergies and no new special visit. Denied drug use, alcohol use, and tobacco use, sexual activity, denied suicidal ideations, satisfied with body weight, and healthy peer relationships  On 31-Jul-2020, the patient received 0.5 ml of booster dose of suspect MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE (Single dose vial, lot U6596AB and expiry date 24-May-2021) via intramuscular route in the left deltoid as prophylactic vaccination.  On 31-Jul-2020, the patient felt dizzy (dizziness) immediately after receiving vaccine MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE.  On an unknown date, the patient was reported to have syncope for approximately 1 minute (Unknown latency) following the administration of MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE.  On 31-Jul-2020:  Acoustic stimulation tests - results not provided; on an unknown date: 20 dB (left and right ear. On 31-Jul-2020 at 09:21 am: Body height - 164 cm (5 feet 4.57 inch: 56 th %ile) ;Body mass index - 23.6 (76 %ile : age and sex);Body surface area - 1.7 m3 ; Body temperature - 36.4 Celsius (97.52 Fahrenheit); Respiratory rate: 18 ;Weight-  63.6 kg with clothes (140.21 lbs; 77th %ile); Oxygen saturation - 99 %; Pain assessment-0. On 31-Jul-2020 at 09:21 am, 11:34 am, 11:34 am,11:35 am: Blood pressure measurement - 90/59 (sitting Left arm 2nd % / 25 %); on an unknown date: 97/54. On an unknown date: Blood pressure orthostatic - 107/59 (lying); on an unknown date: 104/66 (standing); Blood pressure systolic : 70 seconds On 31-Jul-2020: Heart rate -: 85 breaths/min; on an unknown date: 67 (lying); on an unknown date: 72 (sitting); on an unknown date: 89 (standing). On 31-Jul-2020 at 09:22 am: Laboratory test - V OD :20/25  and VOS: 20/25. Hearing screening and vision screen done on 31-Jul-2020, patient had no elevated blood pressure  On 02-Aug-2020, the patient developed visual impairment- abnormal vision (visual impairment),  skin striae-minimal on legs, striae atrophicae (skin striae), and vaccine adverse reaction (vaccination complication) 2 days following vaccination. The patient was sent to Emergency department for evaluation. It was reported early varicocele (varicocele) cannot be ruled out.   This case was assessed as medically significant for the events Syncope, Dizziness and visual impairment. The patient was sent to Emergency department for evaluation. No hospitalization was taken place.  Review of system- Diet and Nutrition: Dietary: appropriate dairy intake and Calcium intake and 3 meals/day, wen balanced diet, normal portions, and good eating habits/appetite. Dental: Dental: regular dental visits, brushes teeth 2 times/day, does not floss teeth: and unknown fluoride in water.  Patient had no snoring, difficulty in falling asleep, or trouble getting up and sleeps through the night, had normal consistency and bowel movement frequency, was aware of pubertal changes, no vaginal discharge. General Appearance: General: well-developed, well-nourished, and no acute distress, Pupils: rounds equal size and reactive to light, extraocular movements were intact and normal cover, tympanic membranes were pearly good landmarks and pinnae well-formed, Tonsil had no erythema or exudate and were not enlarged, no cervical lymphadenopathy or inguinal lymphadenopathy, thyroid had no cervical lymphadenopathy or inguinal lymphadenopathy, no wheezing, breast had no masses, clear to auscultation, Liver was non-tender and no hepatomegaly. Spleen: non-tender and no splenomegaly. Hernia: no palpable hernias. Cervical Spine: full range of motion and no pain while motion, Skin: Color and Pigmentation: no cyanosis, rash, acne, or pustules and lesions. Mental Status: normal affect and mood.  Other laboratory test were not reported.  The patient was treated multivitamin with fluoride (1 mg chewable tablet, 1 tablet every day) by oral route for 30 days prescribed on 31-Jul-2020 in Emergency room. Patient wore glasses.  Nursing documentation  was reported as vital signs completed by PCT (patient care technician), laboratory corporation order for blood work given to mother at visit and the patient was in stable condition.  The patient recovered from the event syncope and dizziness on an unknown date (it was reported patient denied any dizziness later) while the outcome for all the other events were recovering as patient discharged from emergency room in stable condition.; Sender's Comments: This case involves a 17-years-old female patient who experienced syncope, skin striae, dizziness, visual problem and vaccination complication, following vaccination with MENACTRA vaccine. The time to onset was unknown for syncope and compatible for all the other events. More information needed for the assessment if this case. Based upon the reported information, the role of the vaccine cannot be assessed.