Age: 1.33
Sex: F
Vaccine: FLU3
Symptoms: Agitation, Apnoea, Cold sweat, Coma, Cyanosis
Clinical narrative: 12/3/03 within few hours post injection became "cranky." 12/4/03 blotchy rash around injection site. Still "cranky." 12/5/03 rash gone. Still cranky. Appetite decreased. 12/6/03 am-still cranky. Not eating much. 12/6/03 put in her room by parents. Door closed. Few minutes later, family realized they hadn't heard her. Went in, found her under her bed, unresponsive, eyes rolled back, fists clenched. Some jerking of upper extremities. Respirations absent. Cyanotic, cold and clammy. AFter some rescue breathing by family. Started breathing on her own and crying. Stayed alert-to hospital by ambulance. Follow up on 01/12/04: "Pt is a 15 month pt who was admitted last night because of a significant apneic event and possible associated seizure.  Pt is usually healthy.  She did get her influenza vaccine on 12/03.  Yesterday, 12/06, she was a little whinier than usual but had no fever.  Maybe wasn't eating quite as good as usual.  Apparently sometime in the evening she went into her bedroom and closed the door.  Things sounded too quiet so the parents checked on her and found her still partially under her crib.  She wasn't wedged.  When they pulled her out initially apparently she was limp but her upper arms were flexed and maybe there were a few twitches of her distal upper extremity.  This was bilateral.  Her head might have been turned to one side.  She was blue and was seemingly unresponsive.  Her grandfather was in the house and he came and gave her some artificial breaths.  They had called 911.  Sometime during that call then she did start crying.  Initially when she started coming to she seemed to be somewhat dazed but then seemed to be relatively appropriate for the circumstances thereafter and not clearly post-ictal.  She did not wet her diaper.  In the ER she was afebrile and had normal vital signs, and there was no focal findings of any concern on her exam.  Chest x-ray was obtained which was unremarkable.  Basic metabolic panel, magnesium level, and CBC were also obtained and were unremarkable.  They were going to get a urinalysis but she had some labial adhesions so that was not obtained at the time.  It was decided to admit her overnight for observation.  Because of the apneic episode, and IV was placed.  A bag and mask were put at her bedside ready in case it was needed.  She was put on a continous pulse oximeter.  Overnight she did well.  There were no further events or concerns or new concerns.  Basically healthy child with primary apneic event which may or may not have had with it seizure activity.  If not clear what is the cause of this.  The family wonders about the influenza vaccine, that it had occurred more than 72 hours prior to this, and she has no ongoing neurologic symptoms.  She was not tightly wedged under the bed.  The parents stated that there is no bar or any other structure where her head was right there were she could have hit her head.  She did not have coughing or choking subsequent to the apnea.  She had a normal chest x-ray and normal O2 sat, so there is nothing that suggests foreign body aspiration. The medical record received on 1/12/04 states apnea.