Age: 9.0
Sex: M
Vaccine: FLUN(H1N1), FLUN(H1N1), FLUN(H1N1), FLUN(H1N1), FLUN(H1N1)
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio decreased, Amino acid level, Anion gap normal, Antinuclear antibody negative
Clinical narrative: These signs and symptoms are in addition to those reported previously and occurred concomittantly with those previously reported adverse events.  In late December 2009 (I do not recall exactly when but it was around December 27, 2009, when pt was having ataxic gait), pt also had involuntary swaying and movement of trunk and bilateral lower extremities even when he was occupied with playing computer games.  I told pediatrician about these movements back then.  Later, while pt was hospitalized in the hospital from 1/8/2010 through 1/12/2010, he reported the following:  On 1/12/2010, pt's RN told me that pt had reported he felt like someone had hit his muscles with a hammer and they were vibrating. Medical records I obtained reveal that on 1/11/2010, RN had documented "Pt states that both his legs feel funny and like they are vibrating.  Upon walking to bathroom pt is stumbling and taking steps to the side when trying to put one foot in front of the other. Pt reports no dizziness and no HA." Pt. also reported hearing "high pitched machine sounds" bilaterally to me. 1/13/2010:  Has been complaining of joint pain on and off since 1/12/2010. 1/23/2010:  Pt tells me that during the night, he feels his whole body cannot move and he is able to only shift his neck a little and make some throaty sounds.  He says he feels as if he could not breathe at night.    1/27/2010:  Pt. reports hearing screeching sounds in both ears. 1/30/2010:  Medial areas of auricles (ears) are red almost symmetrically and pt complains that ears are hot.  His father and I had observed him eating pancakes the whole time and he had not touched his ears at all.  He also had abnormal personality and abnormal posturing:  Pt. says he feels strange and does not know why and he holds out his hand in a reaching gesture in space and holds this pose.  I ask pt why he does this and he says he does not know, but that he feels like he has not control over it and has to do it.  He stops after a while.  2/12/2010  7:41 PM:  Pt says he feels strange, like the "HULK" does "when he is about to change."  He contracts his right arm and bicep to show me what he means and he types in the computer "hulk" to try to get a video clip of the hulk for me to see so that I would know what he is experiencing, but his muscles start jerking and he is unable to do it.  His apical pulse is 66.  (He has been drinking a lot of water today, and he is drinking a lot even now.)  He holds on tightly to the desk and chair arm rests, but his limbs keep jerking.  I reassure him that he will be ok.  He takes a couple of deep breaths and I ask him why he does this.  He says he does this to try to calm his body down.  Jerking later resolves on its own. Later at 8:10 p.m., pt.'s fingers open and close rhythmically and he asks me why he can't stop himself and he asks me if I have something he can squeeze because he can't stop himself.   I don't know how long these movements persisted. 2/14/2010:  Pt. says he feels like his muscles are quivering.  Denies headache or dizziness. 2/18/2010:  Office visit to pediatric cardiologist due to fainting spell on 2/6/2010 and pulse of 50 on 2/15/2010.  BP 102/57, P 68, jerked in cold exam room.  Pt also made repetitive movements of his feet and said he could not stop the movements. (dystonia?) He yawned and appeared tired at times.  His affect was flatter than normal.