Age: 28.0
Sex: F
Vaccine: FLUX
Symptoms: Muscular weakness, Neurological examination normal, Nuclear magnetic resonance imaging brain abnormal, Nuclear magnetic resonance imaging spinal, Ocular hyperaemia
Clinical narrative: This 40 yo female reported two episodes of R>L lower then upper extremity tingling, numbness, loss of muscle control to right foot resulting in a fall following TIV in 2000 and again after 2003 influenza vaccination. She recalls approximately 1 hour after receipt of her 12/8/2000 influenza vaccine while driving home her right foot felt "weird" and tingled. She completed the 1 hour drive home, showered, ate dinner and went to bed. Upon awakening the next morning (12/9/2000) she stepped out of bed only to fall to the floor with no feeling to right foot and has tingling sensation (painful, pins and needles). Records document complaints of constant prickly painfully sensation with weight bearing only; however she recalls this sensation was to the entire right side of her body within 24 hours. She reports no muscle control to right foot. Her husband picked her up and carried her to their car where she was taken to nearby ER. By the end of this day she reported tingling and numbness to both left and right feet, legs, arms and hands. She denied any fever, breathing problems, difficulty swallowing, headaches or chest pain. She denied any recent illness or exposure to (lived with spouse and 3 year old daughter). She reported no further flu shots until 2003 (date unknown) when she again felt bilateral numbness and tingling (starting in feet and progressing up legs then hands and arms) within a few hours after vaccination requiring use of crutches x1 day. Full sensation to all areas within a few days but it took approximately 1 month for sensation to return to her feet. She recalls this provider advising she had Guillain Barre syndrome. A review of her medical records was unable to locate date of 2003 or 2004 influenza vaccine administration. However, her records document an ER evaluation 9/14/2004 for tingling to right hand, fingers and foot x3 days with dizziness and frontal headache over right eye x6 hours. Her neuro exam was normal with CT head, CBC, chem7, and urinalysis all normal. She was treated with IV TORADOL with resolution of all symptoms about 4 hours later. She was diagnosed with paresthesia. Neurology evaluations for subjective right upper/lower extremity weakness (problems with push-ups) gave diagnosis of paresthesia. Her MRI 10/30/2004 showed abnormal signal intensity suggestive of multiple sclerosis. Variation in symptoms such as extremity tingling, numbness, visual disturbance, loss of balance, weakness, and sensation loss worsened over the next several years (2004-2012) and were evaluated by various providers (neurology, neurosurgery, family practice). On 1/5/2005 she was diagnosed with paresthesia - MRI showing white matter lesions scattered in CNS suggestive of MS, but she had not yet met the definition for MS having had only one documented attack. Her hospital admission in December 2011 gave a diagnosis of Multiple Sclerosis. She was started on REBIF in February 2012. Her MS is under care of neurology. A review of her immunization records listed documentation of influenza vaccines being given on 3/29/1994, 1/30/1998, 12/8/2000, 1/28/2005, 11/18/2005, 10/3/2007, and 11/20/2008. A permanent medical exemption to influenza vaccine was placed in her records on 9/13/2012. Despite the above documentation, she denied receipt of any further influenza vaccinations since 2003. She also advised she did not experience any tingling, numbness or complaints with any other vaccinations (TD, Typhoid x2, MEN, Hep A, AVA x6) given before or after 2000 and 2003 influenza vaccines.