Age: 11.0
Sex: F
Vaccine: HPV9, MNQ, HPV9, MNQ
Symptoms: Complex regional pain syndrome, Computerised tomogram normal, Contusion, Crying, Decreased appetite
Clinical narrative: On the morning of May 22, 2016 Patient states to her mother. "I forgot to tell you, I hurt my ankle yesterday." On the top of Patient's right foot and ankle area is bruised and swollen. Patient doesn't remember what she did however the day before she was actively playing with her cousins outdoors. At that time, we elevated Patient's right foot, applied ice and gave her ibuprofen. On May 31, 2016 Patient seen by doctor since pain was getting worse. X-rays completed and were normal.  They placed a splint on her ankle and advised a week on crutches for non- wt bearing for ankle sprain. June 28, 2016 Patient seen by Dr. for continued Ankle pain. He placed a walking boot on her and recommended a MRI. July 13, 2016 Patient seen by Dr. for continued ankle pain. Steroid Injections was done. Patient had pain relief for 2 days and then pain returned. July 21, 2016 MRI completed for continues ankle pain. Report reads a small ganglion cyst with the sinus tarsi arising from the anterior subtalar joint. July 28, Aug 8, Aug 10, 2016 Ultrasound therapy completed and kinesio taping done for swelling of right ankle. August 15, 2016 Physical therapy appointment. The therapist assessed that Patient's pain is in the area of the typical sock area of the right foot. Discontinued ultrasound therapy as was not benefiting her. Treated with Graston instrument and commented concern about needing to get blood flow to that foot. Patient continues to wear walking boot since June. August 27, 2016 Patient loses her footing on playground equipment ladder and falls down about 4 feet and her right hip lands on the lip of a slide and then she tumbles down slide. Patient heard a pop in right hip area and has instant terrible pain. ER visit with x-ray completed shows a right anterior iliac spine avulsion fracture. Patient is unable to extend leg or bear weight due to pain and at this time is in a wheelchair. Aug 31, 2016 Patient sees clinic pediatric orthopedic Dr. Another right ankle x-ray is completed. He does not feel she has a ganglion cyst. Recommends a CT of ankle. Also wants to wait for avulsion fracture to heel before assessing any further. Patient is left in horrible unexplained pain in right ankle/foot as well has right hip area. Sept 3, 2016 Patient sees a sports therapist who helps Patient out of wheelchair and teaches her to walk with crutches. Sept 6, 2016 First day of school. Patient attends the whole day but is exhausted, in pain and in tears when I pick her up from school. Patient is given rides to and from school by parents as trying to get and off bus with crutches, in pain and worrying about someone bumping her on the bus. Sept 9, 2016 CT scan right foot/ankle completed. Sept 19, 2016 Patient home sick from school with stomach ache, nausea, and vomiting. Patient has no appetite. Sept 20, 2016 Receive letter from Dr. that CT scan is normal. States he would see Patient again for ankle pain when avulsion fracture is healed. Sept 23, 2016 Patient has eye Dr Appt. She had been complaining she can't see and eyes hurt since April. Oct 10-14. Week of school homecoming. Patient is not able to participate in normal activities. She is on crutches and struggling with continued pain in right ankle and right hip area. Oct 31, 2016 Patient is seen by Dr. for follow up of right ankle pain. When Patient is asked to walk without crutches, she drags her right leg like someone who has had a stroke. During this appointment doctor notes she has weakness and possible nerve involvement in right lower leg. Its discussed this is possible CRPS. Nov 2, 2016 Physical therapy is started for right leg weakness and pain. Patient continues with PT 2-3 times a week for the next 2 months. Nov 3, 2016 Patient comes home from school sobbing that her pain is not tolerable. She complains of pain in her right ankle, right hip and her back. Nov 14, 2016 Take Patient to ER at Clinic for continued pain. Nov 15, 2016 Patient sees Dr., pediatric neurology. MRI lumber Spine completed. Nov 16, 2016 MRI of the pelvis completed. Nov 23, 2016 EMG is completed under sedation. Nov 23, 2016 we receive call from Dr. that all tests are normal. Dr. also calls and states good news all tests are normal. Bad news he feels they have exhausted all they can do and recommends seeing pain doctor for diagnoses of CRPS. Nov 27-29 Patient home from school with nausea, stomach pain, and vomiting. Dec 3, 2016 Patient again up during the night with vomiting. She is unable to attend the cheer competition with her team to support them. She spends most of the day in a chair with ear buds in place. She wants the room quite and dim. Starts her head hurts and not tolerating any light or noise. Also states stomach pain as well as pain in back, right hip and right ankle/foot. Dec 5-7, 2016 Patient again home from school with nausea, vomiting, and pain. Headaches seem migraine like in nature. Dec 7, 2016 a last min appointment becomes available for Patient to see Dr., Pain specialist at Clinic. He disguised her with CRPS. January- May 2017 Patient attends pain program at Hospital. Over the next few months Patient is able to regain function of her right foot/ankle and it able to get off crutches. Pain continues and Patient struggles with nausea, vomiting, headaches and starts having issues with dizzy spells, ringing in the ears. Patient misses 50 some days of school this school year between doctor appts, tests, PT and ill days. June 7, 2017 Patient sees Dr. pediatric GI specialist at Clinic for continued nausea, vomiting, and stomach pain. June 28, 2017 Patient sees Dr. at clinic and after tilt table test Patient is diagnosed with postural orthostatic tachycardia syndrome, POTS. July 18, 2017 Gastric empty test is completed and Patient is diagnosed with gastroparesis. January - May 2018 Patient was treated at the neurologic relief Center with Dr.  Before the vaccines on Feb 29, 2016 Patient was a vibrant, healthy, and 11 year old. She was part of a competition cheer team, on the A honor roll at school. Involved with 4H and showed rabbits and poultry. Involved at church and attended youth group. She had many friends that she enjoyed spending time with. She would water ski and goes tubing behind the boat in the summer. On Feb 1, 2016 she was seen for a left foot injury that healed with rest. The difference between that injury and the ankle sprain on May 21, 2016 that caused pain that never went away and progressed to being diagnosed with CRPS, POTS, and gastro paresis. The Vaccines on 2/29/16. Patient now suffers with daily debilitating pain that has spread all over her body. Nausea, vomiting, dizziness, ringing in ears, lack of energy, difficulty sleeping are all part of her daily life. She no longer is able to attend school. No longer on the cheer team. No longer shows for 4H or attends youth group. She rarely sees friends. Her life as she knew it has been changed due to HPV and Meningococcal Vaccines.