Age: 11.0
Sex: F
Vaccine: HPV9, MNQ
Symptoms: Pallor, Reading disorder, Tachyphrenia, Vision blurred, Visual impairment
Clinical narrative: Patient "dizzy" after receiving both HPV and MCV Vaccines @ physical. Sx within 30 minuts. HA, blurry vision, did not understand some words). Slept x 1 hr and improved. Recurred sx 2 days later - see ER Note. Patient is a 11 year old female. Seen earlier today for HSE, and received HPV and meningococcal vaccines. Within 30 minutes, developed a headache, visual disturbance (blurry and couldn't read clearly, and didn't understand some words. Complained of dizzyness. No vomiting. No LOC. Did nap for 1 hour. felt better after the nap, and only symptoms now is a mild headach. Denies any illness symptoms at this time. Sat Aug 3, 2019 4:25 PM: Patient is a 11 year old female with PMHx of ADHD who presents today with headache. 3 days ago had meningococcal and HPV vaccines at PCP. Approximately 25 minutes later complained of a headache, and felt that although she could see the letters on a text message she was not able to verbalize her words out loud. Had no facial droop at that time or weakness. PCP had patient return to office and was observed with no further symptoms. They plan to report this to vaccine injury reporting. The following day had a brief headache as well, this time without any changes in reading, and felt better after laying down. Yesterday overall felt well, although did mention some mild abdominal pain and nausea yesterday. No vomiting. No fevers. No dysuria. Today she was at the mall, developed a headache that was significant enough to cause her to have to lie down at the mall. Mom notes that during the headaches being only sometimes looks a little pale. Patient also reports that earlier prior to the headache, she felt that she had a gap in her vision, where there was a banner that said "family 2018" and she could only read the word family. This has resolved. Currently reports 3 out of 10 headache mostly centered over her right occiput and right frontal area. Feels worse when she turns her head. No headaches waking her from sleep, no balance changes, no behavioral changes, no recent trauma, no polyuria or polydipsia, no weight loss, no fevers, no cough, no congestion, no syncope. No increase in pain with valsalva or coughing. Also reports that she had a brief episode of chest discomfort 2 days ago, no palpitations, no syncope, self resolved. Has no other history of chest pain, no chest pain with activity, no skipping beats. Mother does also note that patient has had some new stressors including starting middle school and upcoming dental extraction. She does note that patient sometimes has anxiety related to stressors, but typically is present more with racing thoughts and has never presented with other somatic symptoms. Has not yet started menses, grandmother started approximately to be this age, patient's mother did not have menarche until 2 years older than patient. Spoke with PCP today regarding ongoing symptoms, and they recommended MOC bring patient in for eval at ED. Also reports sometimes feeling lightheaded with headaches, although not always. Headaches do happen when standing up but also happened once when lying on couch. Has never had any alterations in level of consciousness with these.