Age: 19.0
Sex: F
Vaccine: HPV4
Symptoms: Hypoaesthesia, Hypoxia, Opisthotonus, Paralysis, Peripheral coldness
Clinical narrative: Patient received HPV vaccination.  She then went into blood drawing area to have blood checked for anemia.  This was 45 min after vaccination. All was going well and then she felt odd, hands went numb, became temporarily paralyzed, could not move arms and difficult time speaking all the time alert to what was going on.  She became ice cold, blood would no longer flow, she was eased to the floor, and then became very distraught with her inability to move arms, arched back, shivered.  She did not lose bladder control, did not become diaphoretic as I would expect with a vasovagal response, she did lose partial memory for some of the event but was able to relay my phone number to the phlebotomist who called me, her father and a physician.  Ambulance was already called and arrived just as I arrived, because she was not responding to regular supportive measures.  After one hour of stable vitals she was able to sit up, and after 90 mins she was no longer orthostatic and she was able to leave the clinic. I was called to the blood draw clinic at 12:48 PM.  It took 90 mins for patient to be able to stand and get food, fluids etc.  Phlebotomist did complete her draw with no vagal reaction to this second attempt.  We left the clinic, got light lunch, fluids, and after 2.5 hours she was safe to drive home. She followed me.  She slept for two hours that afternoon and seems to have no more adverse affects.  I suspected a vagal response and she insisted she had blood drawn before and this has never happened, and the paralysis of her hands and arms she found spooky, and terrifying.  She had numbness of her hands but no peri-oral numbness until she began to come around and then became weepy.  She responded to attention, but her extremities were quite cold, hypoxic appearing, yet she was not seen to hyperventilate or hypoventilate.  The ambulance took a biox, I do not have that report, the ambulance also took vitals and I was told they were stable.  I am a physiatrist and I was most concerned about learning if she had fallen and hit her head.  I was assured she had not. I am also an acupuncturist and needled GV 27 a point used in acute syncope, and HT 7, used for anxiety, my presumptive dx at the time was still vasovagal reaction.  She responded became more alert and less anxious.  Her color improved but as I said it took 90 minutes before she could hold her head up without being symptomatic.  Although I suspected a vagal response she insisted it was not, and my wife, not a physician, read the patient education literature from the physician's office and proposed to me, this evening, that this may have been an adverse reaction.  I decided to read the material myself and I am inclined to agree with her.  At the very least we do not intend to give her the second dose of HPV.  The paralysis was the feature most disturbing to my daughter and not what I would expect with either hyperventilation or vasovagal reaction.  I see both in clinic with some frequency and this episode just did not fit, yet I led myself to believe this was all that had taken place.  My daughters insistence that she knows what it is like to faint and this was very different, leads me to believe this was an adverse reaction.  She has returned to college and has no complaints now.