Age: 35.0
Sex: F
Vaccine: MMR, TD
Symptoms: Tenderness
Clinical narrative: Information has been received from a nurse and a physician concerning a 34 year old female with a history of sore throats and lymphadenitis in January 2002 who on 7/28/03 was vaccinated upon immigration with a first dose of MMR  (643392/0525M; J011010). Concomitant vaccination on 7/28/03 included a dose of diphtheria toxoid/ tetanus toxoid. A few days later, the pt had pain in both legs, with swelling of the knees and walked with a limp. About a week post vaccination, on approximately 8/4/03, the pt developed fatigue and tender painful joints. On 8/21/03, the pt was seen by her primary care physician, who treated her with a 10 day course of anti-inflammatories. On 9/8/03, the pt was seen because her right knee was getting worse with increased pain and swelling. She was seen by an orthopedic physician who ordered another 10 day course of anti-inflammatories and immobilization of the right knee, physiotherapy and no weight bearing. On 9/10/03 the same symptoms of the right knee were now in the left knee and the pt was seen again by the orthopedic physician who ordered her a wheelchair and the same treatment for the left knee. Her symptoms continued to progress through September 2003, with an inflamamtory feeling in both legs. The orthopedic physician referred the pt to a rheumatologist. All of the diagnostic tests performed have been negative (MRI, body bone scan). The current status of the pt as reported on 10/15/03 was that she was still in a wheelchair and that the rheumatologist had not diagnosed her with a condition as of yet. On 10/16/03, the rheumatologist reported that the pt can barely walk 1/16th of a block. Initially, joint pain was in both knees, but knees have improved somewhat, now pain is in wrists and ankles, and ankles are filled with fluid. Physical therapy made the pt worse. The pt cannot take NSAIDS and did not want to be placed on prednizone. It was also noted that the pt had an extensive travel history and the pt had received multiple immunizations in the past. The pt's fatigue and tender painful joints persisted. Upon internal review, fatigue and painful tender joints were determined to be other important medical events (OMIC). The reporter expressed a concern about the lot. Additional info has been requested.  Follow up on 11/13/2003: "The patient's fatigue and tender painful joints persisted.  Upon internal review, fatigue and painful tender joints were determined to be other important medical events (OMIC).  The reporter expressed a concern about the lot.  The records of testing prior to release of this lot have been checked by Quality Assurance and found to be satisfactory.  The lot complies with the standards of the Center for Biologics Evaluation and Research and was released.  Additional information has been requested." Follow up on 11/25/2003: "On 11/12/2003 the physician reported that the patient still complained of right knee pain and weakness.  Upon internal review, fatigue, painful tender joints and weakness were determined to be other important medical events.  The reporter expressed a concern about the lot.  The records of testing prior to release of this lot have been checked by Quality Assurance and found to be satisfactory.  The lot complies with the standards of the Center for Biologics Evaluation and Research and was released. Additional information has been requested."