Age: 44.0
Sex: F
Vaccine: MMR
Symptoms: Arthralgia, Feeling abnormal, Laboratory test abnormal, Lethargy, Tinnitus
Clinical narrative: Information has been received from a physician concerning a 44 year old female with asthma and fibromyalgia who on 2/14/02 and on 3/5/02 was vaccinated with a 1st and 2nd dose of MMRII. Subsequently, after the 1st dose, the pt reported "feeling differently" and developed arthralgia, vision problems, lethargy and ringing of ears. It was noted that, after the 2nd dose, the pt had a worsening of these symptoms. The physician had done sedimentation rates, CBC, CPK and had ruled out thrombocytopenia, with the pt's platelets within normal range. The physician told the pt to call if she feels worse and prescribed a non-steroidal anti=inflammatory (rofecoxib). Additional info has been requested.  Reported on 06/04/2003: "Information has been received from a physician concerning a 44 year old female with a history of right ear pain (otitis media), temporomandibular joint disorder, abdominal pain, asthma and fibromyalgia who on 01/28/2002 (previously reported as 02/14/2002) and on 03/05/2002 was vaccinated with a first and second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation), respectively.  The patient had been taking glycopyrrolate (Robinul 2mg TID) and rabeprazole sodium (Aciphex 20mg).  Subsequently, after the first dose, the patient reported "feeling differently" and developed arthralgia (multiple joint pains), vision problems (blurred double vision), lethargy, ringing or ears, and paresthesias of upper and lower extremities.  It was noted that, after the second dose, the patient had a worsening of these symptoms.  The physician had done sedimentation rates, CBC, CPK and had ruled out thrombocytopenia, with the patient's platelets within normal range.  On 03/08/2002 the patient was seen in the physician's office for evaluation of symptoms.  The patient felt ill and complained of some nausea.  The vital signs were reported to be BP 139/81, P 113, R 16 and had a body temperature of 96.9 deg F.  The patient's body weight was reported to be 107lbs.  The lungs were clear and COR = RSR.  A neurological exam was described as "grossly intact".  The impression reported was a "vaccine allergy, probably to the rubella component."  The physician counselled a health department who recommended no intervention other than non-steroidal.  The physician instructed the patient to call if she felt worse and prescribed a non-steroidal anti-inflammatory (rofecixib).  The patient was to be seen in a week, however a CBC, general profile, rheumatoid factor, ANA and Lyme titer were planned in the meantime because of poly arthralgia.  It was noted that immunization in the future should be given with "great care."  The patient was seen again by the physician on 03/15/2002.  A CBC, Lyme and ANA were obtained.  The sed rate and general profile all proved to be unremarkable except for indeterminate ANA (1:80).  The patient complained of tinnitus R not previously noted.  The patient also complained of some persisted double blurred vision.  The patient also complained of paresthesias of upper and lower extremities.  The patient however denied any fever, shaking chills, nausea, vomiting and diarrhea.  The patient's vitals were BP 118/76, F 82, R 16 and T 96.5.  The lungs were clear and the COR = RSR.  The DTR's were slightly hyperreflexic, and motor and sensory were intact.  It was noted that "Romberg ? positive," EYES = PERRLA, and EOM's ? There was a suggestion of possible R lateral erectus abnormality (6th nerve).  The patient's eyes straight ahead showed slight medial deviation.  The physician's impression was reported as "probably drug reaction from (measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)."  The patient had planned to be seen in two weeks.  The patient was instructed that if symptoms of tinnitus or neurologic symptoms should worsen, a neurology consult should be discussed.  On 05/22/2002 the patient was seen in the doctor's office for evaluation of "low back pain radiating anteriorly right."  It was noted that the patient was right hand dominant.  The patient also complained of bloating, constipation, and fullness just beneath ribs right.  The patient has noted "questionable fullness for several months."  It was noted that the patient had a history of fibromyalgia and GERD (Aciphex and Robinal tid (Robinal anticolonergic medication)).  the physicial exam reported the BP 129/64, P 91, and R 16, afebrile.  the patient's weight was 108 lbs.  The abdomen was soft and bowel signs were positive.  Hepatosplenomegaly was not noted.  The rectal exam was deferred.  There was a "questionable fullness" in the rectus sheath right.  There were trigger points over the trapezius right and also the latissimus dorsi.  The impression was "probably fibromyalgia."  The patient also had constipation, IBS, and GERD.  The patient was given Colace 100mg BID.  The plan was to hold glycopyrrolate (Robinul) and metanucil and gave MiraLax for constipation.  The patient was to be seen in 10 days.  The patient was also to continue Protenox 12.5-25mg.  It was also suggested that the patient have exercise programs and massage therapy and hot/cold soaks to back.  Additional information has been requested.