Age: 17.0
Sex: F
Vaccine: HPV4, MNQ
Symptoms: Gait disturbance, Headache, Injection site pain, Laboratory test normal, Lumbar puncture normal
Clinical narrative: From the time of vaccination until about a month after, I experienced moderate pain in my left arm at the injection site and in the entire arm and had pain when trying to move it. By that time, school had started on Sept 26, and over the course of the next few months and to the present I began to (and still) experience weakness, dizziness, and fatigue, sometimes with episodes of confusion or disorientation. No matter how much rest or sleep I get, I still experience those symptoms. Also during this same time period, I began to get chronic headaches that varied in severity and struck suddenly during everyday activities. I know for a fact that the headaches were neither due to dehydration or heat stroke because I drink 2 liters of water daily and it was the winter season. In late 2008, around early December, I began to notice something off in my vision. It seemed that when I looked at straight lines, like edges of a wall or a doorframe, etc, the surfaces seemed to shake. All of my symptoms persisted into the new year and the dizziness and vision problem worsened. During January 2009, I started to become so dizzy that it began to affect my balance. I would start stumbling or have errors in depth perception and walk into walls or other solid objects. The vision problem, after doing some online research, I believe is a condition called nystagmus, started to affect not just straight-line figures in my vision, but all shapes and figures. Soon I was seeing my entire environment seem like it was all vibrating or oscillating from side to side or up and down very rapidly. These symptoms, along with the dizziness continued up until February 27, 2009. On the morning of Feb 27, at 8:00a I had just woken up and started to brush my teeth  when blood started streaming out of my nose. I hadn't irritated my nose by blowing it or picking it and my nose wasn't too dry either. It was a completely random occurrence. It just started bleeding and it wouldn't stop. Within five minutes' time so much blood had flowed out that it was all over my face and my bathroom sink looked like something out of a horror movie. I tried to use tissue to ebb the flow, but I bled right through the tissue in a matter of seconds. My blood wasn't clotting at all. In a moment of panic and what I thought was a good idea to get the bleeding to stop, I reached under my sink and to grab a Super Plus absorbency tampon and removed the insertion tubes and put the tampon in my nose. My nose continued to bleed for the next two hours before it finally stopped (10:15a). About four to five hours later, I experienced the worst headache I'd ever had. I was completely incapacitated. I couldn't even lift my head or even try to think because it hurt so much. I just laid on my living room sofa from the onset of the headache, not moving until I had to go to bed at 10:00pm. From 2:15pm until 10:00pm I had been taking 2 Tylenol and 1 ibuprofen for the pain (every 4 hours for the Tylenol, every 8 for the ibuprofen--I followed all dosage directions properly and did not overmedicate), but it was having no effect whatsoever. While I had the headache I felt very dizzy and disoriented even though I was lying down and not moving. I suffered with these incapacitating headaches for the next six days and had to continue to attend school. At school, the headaches came up on me from doing any form of physical exertion, even things as simple as walking or climbing up a couple of stairs on campus. (I have no heart problems nor diabetes nor am I obese. I am at a healthy, normal weight for my age and height and I have a healthy, normal heart.) At school, there were many instances where I became so dizzy I thought I was going to pass out. I never lost consciousness, but when I got home and my head was still pounding, I would eat, finish homework, and then go to sleep--it was the only thing that I could do to stop feeling the pain, if only for a few hours. But even after sleeping, I would wake up with the same headache. During classes, my vision-shaking got even worse. It became difficult to read lecture slides on the PowerPoint presentations during classes because the letters kept moving. The vision shaking, headaches, dizziness, weakness, and fatigue continued and finally, on March 5, 2009 at around 3:00pm I went to the ER to seek treatment. After a battery of tests that came back normal, I was recommended by the doctor on call at the time to see a neurologist. My discharge papers seemed to indicate I had migraine headaches. The doctor had prescribed Tylenol 3 with Codeine for pain and I left the hospital later that evening. I filled the prescription and began taking a single dose every time my headaches arose. Since then until now, my headaches hit me at random and can be very mild or, as recently as yesterday and today, be severe and crippling, preventing me from doing any type of activity. I have at least two headache 'attacks' a month and they last for several hours over the span of several days. My dizziness has also gotten worse and I have lost my balance on at least three occasions and have fallen to the floor, luckily, I have avoided bodily injury and my falls were in open spaces. However, I have had some close calls and have lost my balance and have nearly collided with large objects that could do me serious injury (corners of counters or tables/desks/cabinets/etc, walls, doorframes). My eyes have continued to worsen. Although I can still see, my vision has been inhibited from the continuous shaking/vibrations of everything in my surrounding environment. The dizziness, headaches, and vision problem still persist and moderately impacts my life. It makes it VERY difficult to function normally whenever my headaches strike or if my dizziness becomes too intense. The vision-shaking is manageable, but when that too, becomes too severe, it makes me feel nauseous and makes me dizzy, which in turn, exacerbates my existing dizziness. When both of the dizziness symptoms combine, I tend to have difficulty keeping myself from falling, and something as simple as sitting up from lying down or getting out of bed in the morning sets off the dizzy spells. I don't know how to treat the dizziness or the condition with my eyes and have since just been dealing with it. The headaches, I had been treating with my prescribed medication, but it has since run out. I've been trying to manage it with regular Tylenol, but it's had little to no effect. Since the initial onset of my symptoms last fall, nothing has improved. (Other notes: Prior to my ER visit, my mom asked me to send her an email of my symptoms to consult with a doctor as to whether or not I should be brought in to be seen. I still have the email and it gives a somewhat more detailed account of the events of Feb 27 leading up to the evening before I went to the ER)  9/1/09 ER records received DOS 3/5/09. Assessment: Acute Cephalgia. Patient presents with headache x10 days, pain pressure like. Dizziness worse with movement. Spontaneous nosebleed. Discharged improved.