Age: 16.0
Sex: F
Vaccine: MENB, MNQ
Symptoms: Oropharyngeal pain, Poor quality sleep, Sleep disorder, Tinnitus, Tremor
Clinical narrative: ED on 9/16/2024: Patient is a 17yr female who presents for evaluation of headache, chills, shakiness. The symptoms started an hour after she received the meningitis vaccine. She received 1 shot to each shoulder, receiving the meningitis B Bexsero and the meningitis AC WY. This occurred 2 weeks ago, continue to have symptoms, therefore returned here. Mother states that shakiness seems to affect just the right side of the body when this happens. Does not happen every day, happens transiently.  Seen in ED 9/20/2024: Patient is a 17yr female who presents with continued headache and occasional tremors. This has been ongoing since she got a meningitis vaccine 18 days ago. She was seen in this emergency department 4 days ago with the same symptoms. She does not have a local primary care provider she uses a primary care provider/pediatrician in another state. She reports she has had a health for the last 8 days since these vaccines. She reports about 1/2-hour after vaccine the vaccine was given she began having a headache. She said this was associated with chills. She has been sleeping poorly in the last 18 days and her mother has noticed she has episodes of tremors with primarily right arm. This occurs both while she is sleeping and also when she is awake. They can occur 3-5 times a day and they can last for up to 2 minutes. She is not unconscious and is aware that this is ongoing. She says that both of her legs feel shaky as well. No numbness tingling or weakness. He has not been incontinent of urine or stool. She has not had a rash. No fever or chills. She denies swelling in her legs or pain in her calves. The workup performed in the emergency department was normal including CRP and inflammatory markers as well as CMP and a CBC. She prior to this was healthy. Pertinent Labs & Imaging studies reviewed. Patient returns with complaint of occasional tremors mainly affecting the right upper extremity as well as headaches. She not have a headache at this time nor is she having any tremors. This was started after getting vaccinations. This is her second visit for this problem. She does not have a primary care provider. Here she looks very well she does not look toxic or septic and has a normal neurologic exam. She has no deficits. She has no rash she looks well-hydrated I highly doubt this represents a dangerous process. I think it is unlikely to be a seizure but that would be on the differential diagnosis list. Perhaps it is a side effect of this vaccination but I think it is that is the case it is self-limited. I long discussion with the mother I do not think this is emergent or dangerous problem and does not need further workup in the emergency department but she does need close follow-up with primary care provider we discussed the importance of that. I suggested the clinic. She may also benefit from seeing a pediatric neurologist we discussed that mother verbalized understanding and seemed disappointed no further workup was good to be performed emergently through the emergency department I tried to explain with to her why that is and to reassure her but am certain if it had desired effects. Once again this child looks very well I see no indication for further workup at this time she is stable for discharge to follow-up with her primary care provider. Seen in clinic 9/23/24. Received her second MCV4P meningococcal and first Men B vaccine on Sep 2. A few hours later developed headache and shaking. Also with ringing in her ears and a burning sensation. Over the next few days felt warm on and off. Had a sore throat. More tired then usual but has been having trouble sleeping because of the headaches. Symptoms have been gradually improving. Labs as ordered. Since symptoms are gradually improving, do not need neurology referral at this point. Discussed that no way to tell if from the vaccines or not but due this would not advise the Men B booster. Phone call 9/25/2024: Called mother to report that lab work from last visit all normal. Discussed whether to have neurology referral now or wait a few weeks to see if symptoms continue to resolve. Mother would like to get ahead with referral now.