Age: 1.25
Sex: F
Vaccine: MMR, VARCEL
Symptoms: Agitation, Breath holding, Convulsion, Electroencephalogram abnormal, Irritability
Clinical narrative: Information has been received from a physician concerning a 15 month old female with a history of jaundice, breath holding spells which might have been "undiagnosed seizure activity," and otitis media who on 2/9/02 was vaccinated with a first dose of MMR II SC in the left thigh. The pt was concomitantly vaccinated with varicella virus vacine live. On 2/18/02 the pt was taken to the ER with seizures and was admitted to the intensive care unit. The pt remained in the hospital for a couple of days. Lab evaluations revealed that all lab bloodwork was negative. A MRI was normal, and an electroencephalography had a few spikes out revealed normal neurology. The pt had no fever, but did have a generalized rash all over her body. At follow-up examination at the office, the pt had normal, alert reaction, was crawling and active and presented with no seizure activity. The pt had not recovered from the generalized rash. Additional info has been received from the physician via medical records. The pt was a former full-term, normal spontaneous vaginal deliver. Birth weight wsa 7 pounds 4 ounces. There was a hisotyr of jaundice, but no other complications. The pt had no history of any kind of tonoclonic movement to the extremities. The pt had been diagnosed with breath holding spells occurring when the pt was upset. She would hold her breath and had loss of consciousness lasting about 10 seconds with nocyanosis or tonoclinic movement. There was no family history of febrile seizures or neurologic conditions. The pt had no known allergies or concomitant medications. The pt was seen by the primary physician for a well child check and received MMR and varicella vaccinations on 2/9/02. The pt was status post two antibiotic courses for bilateral otitis media that was initially diagnosed in January 2002. The pt was status post Suprax for 10 days. The pt was antibiotic free for approximately 5 to 7 days prior to her well child check, and the otitis media was completely cleared at that time. On approximately 2/16/02, the pt awoke and had the beginnings of some rhinorrhea, but at that time had no cough or fever. The pt awoke from her nap around 15:30 with a runny nose and was a little fussy, while the pt's father was holding her, the pt had a shuddering episode that lasted approximately 2-3 secnds. The pt cried immediately afterwards. There was no loss of consciousness, rolling of the eyes, or cyanosis. The pt had a couple of these episodes. The pt felt warm to touch and had a temperature of 101 degrees F rectal. The pt was taken to the ER for evaluation and subsequently hospitalized. Vital signs on arrival to ER were temp 99 degrees rectally, heart rate 120, respirations 24, blood pressure 116/66mm/Hg, weight 22 lbs. The pt wsa saturating 99% on room air. The pt had a macular pinpoint rash on her torso, diffusely on her abdomen and back that blanched when touched. Th ept had a lacy appearance to her skin and torso. The pt also had a viral syndrome, congestion, itchy eyes, and diarrhea. The pt subsequently had 3-5 episodes of "shuddering" then crying after. The pt was treated with lorazepam, acetominophen or ibuprofen as needed. On 2/19/02, lab evaluations revelaed blood urea nitrogen was 5mg/dl and phosphorus was 4.1mg/dl. On 2/19/02, an electroencephalogram revealed a mildly abnormal EEG, due to minor irregularities of cerebral function. The background activity consisted of 5-6 Hz per second which was fairly well organized and symmetric without any obvious focal or diffuse slow-wave abnormalities. Intermittent was intermixed delta and theta activity and copious muscle and movement artifacts, especially in the beginning of the tracing. During the sleep recording, spindle activity which was synchronous and symmetric was recorded and occasioanl vertex as received as well. Rare broad sharply contoured waves were seen in the central and parietal regions on the left. The pt was hospitalzied for 3 days. The pt subsequently recovered from the shuddering, crying and fever. Medical records indicated that it was believed that the pt had a simple viral syndrome with associated fever and chills. Given that the pt was febrile at that time, it was believed that the pt's episodes were more consistent with regoring episodes or trembling associated with temperature. The pt's episodes were not consistent with the seizure activity that was associated with MMR II, but the pt may have had an attenuated version of the virus and might have had some mild viral symptoms as a result. The reporting physician felt that the pt's shuddering, crying and fever were other medical events (OMIC). No additional info is expected.