Sex: F
Vaccine: FLU(H1N1), FLUX(H1N1)
Symptoms: Autonomic nervous system imbalance, Balance disorder, Blood pressure fluctuation, Chest discomfort, Computerised tomogram normal
Clinical narrative: Initial reported received on 14 December 2009 from a physician, via e-mail. The report consisted of an initial post from the treating physician, and a follow-up comments from another physician who had not evaluated the patient. In the initial posting, it was noted that a female hospital employee had received PANDEMIC INFLUENZA H1N1 VACCINE on 11 November (year not reported). The trade name, manufacturer name, and lot number was not reported. Past medical history included hypertension, previously well-controlled on VALSARTAN, "SERTRALINE", and LIPITOR. Forty-five minutes after receiving the vaccination, the patient experienced chest discomfort and a headache. She also experienced two episodes of "paralysis", during which the patient noted that she was temporarily unable to move but could see and hear what was going on. Each episode lasted "maybe seconds". She walked various places before eventually presenting to the emergency room by ambulance. In the emergency room, the patient's blood pressure was around 160/110 mmHg, and she was admitted to the hospital (dates not provided). A CT scan of the brain, MRI and MRA of the brain, EEG, and a nuclear stress test were completed. All the test were normal except for the MRI of the brain, which revealed multiple bilateral white matter hyper-intensities. The patient was evaluated by a neurologist, who noted that her neurological exam was normal. It was the opinion of the neurologist that the patient had experienced syncopal episode. The patient did not receive any treatments with steroids while in the hospital. The patient was subsequently evaluated on an outpatient basis by a neurologist and a cardiologist. The neurologist again found the patient's neurological exam to be normal; and a cardiologist thought the patient's fluctuating blood pressure patient's neurological exam to be normal; and the cardiologist thought the patient's fluctuating blood pressure was due to autonomic dysfunction. At that time, the overall impression was that the patient's symptoms were due to a vaccine reaction, and the patient was expected to have resolution within weeks to months. A second neurologist noted that the patient's symptoms were not "Guillain Barre, or any previously described neurological reaction to the vaccination." On 14 December 2009, the patient was evaluated by the reporting physician for possible return to work. At that time the patient was still complaining of a constant headache and anterior chest discomfort. Examination revealed the patient's blood pressure to be 160/106 mmHg, and her pulse was regular. The reporter noted that the patient's blood pressure was elevated, and seemed to fluctuate among doctor visits. It was noted that the patient's blood pressure was elevated, and seemed to fluctuate among doctor visits. It was noted that the patient's blood pressure medications had been increased over the previous two weeks. Neurological examination on 14 December 2009 was normal except that the patient's balance seemed off with tandem walking. She had 3 plus hyper-reflexive patellar reflexes, and 2 plus reflexes in the triceps, biceps, "Br", and Achilles tendons. There were no appreciated sensory changes or weakness. Per the physician, the patient's symptoms seemed like "acute dissemination encephalomyelitis", or a neuro-related complication bases on the physician's search of the literature. The patient was referred to her primary physician for blood pressure treatment and further evaluation. In a comment to the first posting, another physician gave the opinion that the patient's symptom onset was too rapid for ADEM, or anything other than acute vascular event, of "hysteria", and felt that the brief symptoms of paralysis could not be demyelinating. The rapid fluctuations were not felt to be consistent with organic lesions, and the patient's white matter changes were noted to be non-specific and possibly be related to chronic hypertension. Per this physician, the likelihood of causal relationship to immunization was remote. Documents held by sender: None