Age: 28.0
Sex: F
Vaccine: TD, TYP
Symptoms: Nausea, Pain in jaw, Pallor, Respiratory arrest, Tremor
Clinical narrative: Approximately 2-5 minutes following receipt of her 23 July 2004 vaccinations [TD, Typhoid] while getting routine labs drawn, she began to feel dizzy, woozy and thought this was in response to her blood draw (never had problem before). She returned across the passage way to immunization clinic and advised corpsmen. She was instructed to sit, place her head between legs. When the corpsman applied pressure to back of her head she suddenly rose with an increased sensation of wanting to pass out. She became nauseated, wanted to vomit, and dizziness worsened for 1-2 minutes before easing. Her dizziness was described as her head was spinning without visual problems.  She was instructed to eat lunch (was 11-12 noon) and return for problems.     Approximately 10 minutes later when sitting for lunch she complained of a sensation of "leaving her body" as if her body was floating or very light, increased dizziness, weakness (no energy), and nausea. Friends reported pallor and assisted back to medical. Vital signs were taken with corpsmen having problems obtaining a blood pressure (3 tries), then they went to find the physician. She remembers hearing her BP and pulse were decreasing as she was laid down. She c/o an increased "out of her body sensation and floating", being unsure of events around her, increased problems breathing (unable to breathe in) as if her lungs were being squeezed slowly preventing inhalation. She c/o nausea, severe jaw pain, and problems moving. She recalls an IV being established, her body tensing starting with her jaw with progression to both upper and lower extremities, her arms and legs drawing upward and tensing, inability to lay flat and then nothing. She was advised she had a seizure (sz) and went into respiratory arrest with weak distant pulses. She was treated with IM epinephrine & Valium (IV pulled w/sz), intubated and transported to Medical Center.    While at ER, she was extubated and placed on nasal oxygen, and admitted overnight. While in the ER, she reported a second episode of weakness with body tensing. She recalls triggering the call bell for the nurse and was advised she had had another seizure. She was transferred to Medical Center the next day for various tests (EEG, head scans, labs). She c/o feeling exhausted, sore muscles, headaches, tired, weight loss  of 15 pounds over 7 days (on liquids only). She was seen by an allergist at MC who diagnosed anaphylactic reaction to TD/Typhoid and released home to convalesce w/o limitations to duty. She c/o muscle strength weakness, fatigue and sore muscles with slow resolution of symptoms over next few weeks (2-3 wks) before she felt herself again. She reported no further vaccinations, seizures or recurrence of symptoms. She received the influenza vaccine in Dec 2004 and later Gardasil vaccine x 3 in March 2007 without complications.  10/11/2007 MR received for ER visit 7/23/2004 with DX of Status Epilepticus and Hypokalemia.  Pt had returned to clinic shortly after vax c/o chest pain/SOB and then began seizing.  Presented in severe respiratory distress. Tonic-clonic seizure activity lasted ~30 minutes.  While in ER had one episode of flexion of all limbs, grunting respirations, rhythmic shaking and blinking eyelids.  Transfered to another facility for further w/u. 10/12/2007 MR received for hospital DOS 7/26-28/2004 for DX: Seizures 2' anoxic event during anaphylactic reaction to either Tetanus/Diptheria booster or Typhoid booster.  UTI. Pt was received from civilian hospital for seizure w/u.  HPI as above.  Has had H/A, nausea, and muscle soreness since seizure.