Age: 8.0
Sex: M
Vaccine: FLU3
Symptoms: Dysarthria, Dyskinesia, Face oedema, Tic
Clinical narrative: From initial information received on 16Jan04 from a physician regarding an adverse event occurring, it was reported that an eight year old male pt received Fluzone SV 2003-2004 USP, lot number U1148EA, administered IM on 09Jan04. Two hours post immunization, the pt developed funny movements of his hands and face, with some slurred speech. The pt was seen by a physician. These events still persist and he is being evaluated by a pediatric infectious disease specialist. From additional information received on 30Jan04 from, it was reported that a couple of hours after the vaccine was given the pt's lips swelled up. He did not have difficulty with breathing. Subsequent to that, he had an exacerbation of what was observed to be facial ticks. He also had some finger rolling bilaterally that seemed to be voluntary. He did not run a fever, he had no sensorium changes and there were no difficulties in school. The pt has had a past history of asthma and was on Advair daily including the day of vaccine. After the doctor examined him at the visit, which was routine third grade visit, he seemed congested so the doctor suggested that he be started on Albuterol inhalations. The mother gave him the first dose after they got home a few hours after the injection. He has been on that daily at least once or twice a day as well as Advair until one day ago. It is unclear how long pt has had these apparently nervous type ticks, however the family and teachers have noticed an increase in the ticks and finger rolling episodes. The pt does not seem to be particularly anxious or bothered by these things. He had not had any caffeine or chocolate during the week prior to examination by the pediatric infectious disease specialist on 16Jan04. At that time, the ticks had decreased and the hand rolling episodes had ceased. The pt's mother felt that he was back to usual self. At the visit it was noticed the pt's father also had some facial ticks and grimaces mainly involving the eyes and the lips. The family's interpretation is that with stopping the albuterol, whatever reaction was going is certainly much less. His physical examination was unremarkable with the exception of a slightly elevated blood pressure of 125 in the left arm and 127/68 in the right, possibly due to anxiety. Neurologically he had intermittent facial ticks, mainly closing one of his eyes and grimacing. He had no dysarthria or any overt neurological deficits. During the examination, he had one episodes of pill rolling, which the family has described as the movement of his fingers into the palms bilaterally. The physician felt that this seemed to be voluntary. The pt's motor function appeared fine and he was developmentally and psychosocially intact.  The physician's assessment is this was a possible allergic reaction to the influenza vaccine, as characterized by the swollen lip compound by antiasthma medications, particularly the albuterol, plus anxiety after the injection leading to an exacerbation of an underlying process of facial ticks with some unusual movements of the hands, but which have now subsided.