Age: 46.0
Sex: M
Vaccine: PPV
Symptoms: Myoclonus, Nuclear magnetic resonance imaging brain normal, Protein urine present, Pyrexia, Red blood cell count normal
Clinical narrative: Information has been received from a certified medical assistant and a 46 year old male consumer with "2 forms of cancer" and HIV infection and a history of seizure like twitching during a spinal tap procedure, who on 15-NOV-2010 was vaccinated with a 0.5 ml dose of PNEUMOVAX 23 (Lot # not reported) IM. Concomitant therapy included unspecified sleeping pills. The consumer reported that on 15-NOV-2010 he experienced seizure like twitching in his entire body after receiving PNEUMOVAX 23. The medical assistant reported that the patient developed a generalized twitching on 15-NOV-2010. It was reported that the patient was treated with BENADRYL. There was a MRI Lab performed (results not provided). At the time of the report the consumer stated he was recovering from the seizure like twitching and the medical assistant considered him to be recovered. Follow up information has been received from a physician via a medical record. It was reported that the male patient with a history of human immunodeficiency virus (HIV) diagnosed in 1995, for a year and a half he had acquired immunodeficiency syndrome (AIDS) (but reportedly his numbers were better), neuropathy peripheral, oral cancer, depression, syphilis, and sulfa allergy, and a history of some surgery on his buttock because of what it was thought it was cancer and appendectomy and no illness at the time of vaccination, who on 15-NOV-2010 at 13:30 was vaccinated with an unknown dose of PNEUMOVAX 23 (lot # 667914/1067Z). Concomitant therapy included amitriptyline hydrochloride, lorazepam and THEROBEC. The same day, shortly after arriving to a friend's house, at around 21:00, he started having twitching. On 16-NOV-2010, he went to the emergency room. He denied shortness of breath. He stated he had just been jerking, his head had been jerking and that he was jerking so hard he thought he was having a seizure, but he was awake, alert and aware of everything. He had myoclonic jerks, noticed his head jerked, his arms and legs all jerked at different times. His temperature was normally 95 to 95 and stated that his temperature of 99.3, was a fever for him. No cough. No dysuria. He had never had similar episodes before. He had been doing a lot of work lately remodeling his house and fixing it up and so had been very physical. Blood pressure was 158/105 and pulse 111, other vitals were stable. The physical examine was within normal limits except for his face flushed, calf tenderness or costovertebral angle (CVA) tenderness and was mildly diaphoretic. The patient's myoclonic jerks were quite pronounced and he could reduce the jerking by contracting his muscles, but it did not resolve the jerk all the way. It just reduced the magnitude of the jerk. Magnetic resonance imaging of the brain showed no acute hemorrhage, infarct or mass lesion. Urinalysis traced hematuria. CBC - white count were very normal. Hemoglobin was 18.5, red blood cell count was 5.94, blood hemoglobin was 19.5, mean corpuscular hemoglobin concentration 36.1, blood monocyte count 12.3, urine protein test (2+) 100, urine red blood cell count 2-5, urine squamous epithelial cells test 2-4, urine mucous test 3- and urine unspecified casts was rare. The rest of the labs were normal. The patient was given intravenous BENADRYL and his myoclonic jerks subsided. He was able to ambulate with a steady gait and stated he felt much better. On 17-NOV-2010 the patient would be follow up with another physician. The patient was advised of the results and the plan, and he agreed as well. He was to take BENADRYL every 6 hours as needed for twitching. The patient was advised it would make him sleepy, so no driving while taking that. He verbalized understanding of the discharge instructions and agreed with the plan as stated. The emergency department diagnosis was myoclonic jerks. No further information is available.