Age: 15.0
Sex: F
Vaccine: MNQ, MNQ
Symptoms: Myalgia, Pain
Clinical narrative: Seriousness criteria other medically significant (OMIC). Due to the new medical information provided on 2/1/2006, this case is being upgraded to serious. Initial report received from a health care provider on 1/10/2006. A 15 year old female patient experienced generalized weakness, weakness in both hips, general fatigue, leg pain and pain in both knees, 126 days after she had received an injection of Menactra, lot number U1657AA. Route and site of administration were not reported. the patient was examined, and physical therapy was ordered. The physical therapist felt that the patient had unusual weakness in her hips, and prescribed exercises for the patient. The therapist felt the patients symptoms should improve with the recommended therapy. A CBC, lyme titer, C reactive protein and fasting glucose were all within normal limits. CPK's or a spinal tap were not performed. The patient was scheduled to follow up with an orthopedic specialist on 1/17/2006. At the time of this report, the patient had not recovered. Follow up information received on 1/1/2006 from a health care provider. Due to the new medical information provided, this case is being upgraded to serious. On the date of vaccination, 6/24/2005, the patient complained of a rash on the back of her right knee. The patient was examined on 10/28/2005, and, at the time, the parent indicated that her daughter had been experiencing leg pain (from above her knees to her anterior lower legs) and leg weakness since approximately the middle of Sept 2005. Latency of the events was approximately 12 weeks post vaccination. It was also noted that the patient had aching all the time because she has played soccer and softball for six years. The physicians assessment was leg pains due to soccer, and the patient was referred to physical therapy. On 1/3/2005, the patient was evaluated by a physical therapist. Per his report, the patient had experienced leg pain, weakness and fatigue since the second week of September, and this was limiting her functional ability to resume sporting activities. Upon examination, she presents with significant bilateral proximal weakness of her hip, abductors, internal external rotators and hip extensors. The evaluation included testing for strength as follows. bilateral hip extensions 3+/5, bilateral hip abduction 3+/5, bilateral hip external and internal rotation 3+/5, bilateral hip flexors 4-/5, bilateral quadriceps and hamstrings 5/5, and bilateral ankle, plantar flexors, dorsi flexors, inverters and everters 5/5. All other testing of her lower extremities were within normal limits. A physical therapy plan was initiated. A physical therapy report of 12/7/2005 describes significant improvement of the strength of the lower extremities. The patient was re-evaluated by her physician on 12/9/2005 with continued fatigue, hop weakness and bilateral knee pain and was referred to another physician for evaluation. On 1/18/2006, an order for X rays of the hips, knees and lower back and  MRI of the spine (history of back pain) were noted as well as a neurology consult. The patient will not play soccer in Jan 2006. Documents held by sender, office records, physical therapy evaluation, CBC, Chem panel, lyme titer, C reactive protein, T4, and TSH.