Age: 16.0
Sex: F
Vaccine: HEPA, HEPA
Symptoms: Dehydration, Dizziness, Epistaxis, Headache, Laboratory test abnormal
Clinical narrative: Syncope, dehydration, dizziness, epistaxis, headache. 03/01/2000, the pt experienced the first of many fainting episodes. The reporter noted, 'She goes completely unconscious for about one or two minutes' and 'when she wakes up, she doesn't remember anything about the fainting.' The reporter noted that the fainting had been happening almost every day, sometimes twice a day. The reporter indicated that 'there was a period of seven days with no episodes, however, she experienced two episodes on Saturday, and another on Sunday and Monday.' The reporter noted that the pt had no previous history of fainting episodes or unconsciousness prior to receiving the vax. Unspecified cardiovascular and neurological tests have shown no abnormality. Follow-up information received from a mid-wife revealed that the pt was having nosebleeds as well, described as 'frequently spontaneous and a lot of bleeding.' She had nosebleeds 5-6 times per day lasting 15-20 minutes, but sometimes lasting as long as one hour. Additional follow-up received from a physician indicated the pt was a normal, '100% healthy, athletic' teenager with no significant medical history. She received the vax because she was planning to travel as part of a high school class trip. The physician confirmed he has seen this pt 'a number of times' since March 1st, for what had been described by the pt and her parents as 'fainting episodes.' The physician stated these events have been witnessed by the pt's school nurse, and that at one point, the pt was having as least one fainting episode per day. In addition to the reporting physician, the pt work-ups including numerous lab/diagnostic testing. To date, all test results have been normal with the exception of a 'positive tilt test.' Additionally, the reporting physician noted the pt was 'slightly dehydrated.' As a result, she has been diagnosed with 'neurogenic syncope', which the cardiologist feels is related to her not drinking enough. She experienced dizziness with syncope 3-4 times per week. She also had pain in the left lateral head preceding syncope 5 times in 2 weeks. The pt has been told to increase her fluid intake. The reporting physician indicated he had not spoken with the pt/family since she began increasing her fluid intake, so he does not know if this has resulted in the resolution of the fainting spells. Additionally, the reporting physician confirmed the pt has experienced several nosebleeds, though he did not indicate they were severe or persistent. He stated she has been examined thoroughly, and there is no problem with her nose, nor is there any abnormality with the bloodwork/platelet counts. The reporting physician believes the nosebleeds are unrelated to the neurogenic syncope, and feels that they are 'seasonal.' Though the pt's experiences are temporally associated with the vax, the physician stated that he really does not think the events are related to the pt's vax, though he cannot say for certain they are unrelated. The neurogenic syncope was considered an 'other medical event.' Additional information has been requested.