Age: 18.0
Sex: F
Vaccine: MNQ
Symptoms: Bone pain, Chest discomfort, Chest pain, Dizziness, Fatigue
Clinical narrative: An 18 year old female patient received a first dose of Menactra, lot number not reported, in mid-August. Three hours post vaccination, the patient developed headache, fever and upset stomach. One day post vaccination, the patient experienced chest pain and tightness. Approximately two weeks post vaccination, the patient developed leg numbness and tingling.  The patient was not hospitalized, and reportedly a diagnosis of possible Guillain-Barre Syndrome was considered.  As per the CDC, "we feel the likelihood of Guillain-Barre is very low". The case was referred to CISA for investigation.  No additional information was provided.  At the time of this report, the recovery status was not reported.  This information has previously been reported to VAERS under the reference number 245480 and this report was considered non-serious according to the information extracted from the VAERS database.  The patient's parent was contacted on 14/Nov/2005 by manufacturer in order to obtain additional information.  The reporter stated that the patient received the Menactra vaccine and that evening experienced a fever of 101 degrees Fahrenheit.  She self medicated with Tylenol, but the fever persisted.  Her additional symptoms included shakiness, dizziness, upset stomach and weakness.  The patient moved into her dormitory room at college on 25 Aug 2005.  In September she reported to her mother that she was experiencing tingling in her legs, toes, and feet.  The tingling traveled up her legs.  She also had weakness of her leg muscles.  Approximately one week to ten days later, the patient began to have pain in her chest, back and rib area when she took a deep breath and her heart felt as though it were racing. She was not hospitalized, but was seen by a physician.  As per the patient's mother, the physician felt the patient's symptoms were consistent with a "mild case of Guillain Barre syndrome".  The patient did not have any nerve conduction studies or a lumbar puncture completed.  The on ly testing that the reporter could recall was a hemoglobin of 9.9.  The patient was referred to an allergist for allergy testing, which was negative.  A pulmonary function test was negative for asthma.  No neurology consult has been ordered. The patient was seen by a cardiologist last week and has a follow-up appointment with the responsible physician scheduled on 23 Nov 2005. At the time of this report the patient has not recovered and continued to be extremely tired, have pain with breathing, "heart pounding" and involuntary shakiness in her hands. She has recovered from the tingling in her legs, toes and feet.  Information was received on 16 Nov 2005 from the vaccine provider. The lot number for the Menactra vaccine was reported as U1767AA.  The vaccine was administered intramuscularly in the left deltoid.  Follow up information received on 30 Nov 2005 from the Centers for Disease Control and Prevention.  Other medications include Albuterol inhaler. Pre existing illnesses are listed as "sinus".  Possible mild GBS is reported.  Follow-up information received on 06 Jan 2006 from the Centers for Disease Control and Prevention.  The onset date for tingling and numbness in the legs is provided as 01 Sep 2005.  Follow up information received on 26 Jan 2006 from a physician.  The patient has not seen in his office since November 2005. The reporter does not know the recovery status of the patient.  No further information is expected from this source. Follow-up information received 30 Jan 2006 from a physician.  Per the reporter, the patient had returned to the physician for review of her physical findings on 21 Oct 2005.  The patient had continued to have some very minimal weakness in her lower extremities.  The weakness had progressed from distal to proximal as is consistent with Guillain Barre Syndrome but by the time the physician had seen her she had almost normal deep tendon reflexes and symmetrically normal strength in her lower extremities.  There seemed to be no problem with her upper extremities.  There was a problem associated with respiratory difficulties but that was not in the time consistent with respiratory problems associated with Guillain Barre Syndrome. The muscle weakness and unusual sensations "tingling" reached to her mid thigh but not more proximal than that.  The patient, never to the physician's understanding, had weakness of her upper extremities. The respiratory status could not be associated with weakness of respiratory musculature.  As per the reporter, if this is a Guillain Barre type Syndrome reaction, it is unlikely that it was one serious in nature and is now, for the most part resolved.  From additional information received from the CDC on 31 January 2006, as of 27 Oct 2005, the patient's parent reports that all of the patient's function has returned. The patient has recovered at the time of this report.