Age: 9.0
Sex: M
Vaccine: FLUN(H1N1), FLUN(H1N1)
Symptoms: Positive Rombergism, Pyrexia, Somnolence, Vaccination complication
Clinical narrative: This is an addition to VAERS ID 372236-1 that was previously filed.   12/08/2009:  After returning from the ER, pt. went to bed and sweated so heavily that he drenched his bed linen.  This nightly sweat pattern repeated on 12/09/2009, 12/10/2009, and 12/11/2009. He usually is a sweaty person, but prior to 12/08/2009, he had never sweated so heavily that he would drench the linen.  From 12/12/2009 through 12/29/2009, he has not sweated at night, even when he complained of feeling hot or boiling inside his body.  He did not return to his usual sweaty self until 12/30/2009.  12/09/2009:  Seen by pediatrician as instructed by ER physician; pt. c/o tiredness and sleepiness and exhibited myoclonic jerks witnessed by pediatrician.  No treatment prescribed. We were told to closely observe him and if problems persist, then a neurologist consult could be done.  Diagnoses were adverse reaction to vaccine and myoclonic jerks.   On 12/10/2009:  No more myoclonic jerks noted.  PM:  fever of 99.7 axillary, c/o of not feeling well and feeling hot inside.  Had intractable coughing spells to the point where he would wretch.  (His  complaint of feeling hot inside persists to today; sometimes he describes it as feeling like he is "boiling inside", which makes it difficult to sleep.) 12/11/2009:  Pt. stated he could feel as if the myoclonic jerks were about to start again.  However, they did not materialize this day.  12/14/2009--Seen by pediatrician due to fever, sore throat, intractable coughing spells.  Was told to take albuterol inhaler every fours (he had not needed to take albuterol inhaler since 12/04/2009; it was originally prescribed p.r.n.), prescriptions given for prednisolone for 4 days, azithromax for a 5-day course, and Tussionex p.r.n.  His medical insurance did not pay for Tussionex, so I did not fill that prescription; therefore, he did not take the Tussionex.  Also had chest x-ray which came back clear.  Pt. finished the azithromycin and prednisolone as prescribed and used his albuterol inhaler every four hours for about 5 days, at which time he no longer had coughing spells, so he stopped taking the albuterol.  Diagnosis:  cough persistent.  12/18/2009:  dizziness persisted, heart rate irregular and dropped to 42 once while supine, heart rate 52 when standing up, had headache today. Seen by pediatrician.  EKG done and bradycardia and irregular heart rate noted. Pediatric cardiologist consult ordered asap, reasons:  irregular heart rate, bradycardia, dizziness.  12/21/2009, AM:  Seen by pediatric cardiologist.  Ultrasound of heart done, pictures taken, and cardiologist reports heart structurally normal.  24-hour Holter monitor ordered. Plan was to treat with florinef if bradycardia is the only problem.  (12/ 28/09:  Nurse informed us cardiologist will not be back until 1/4/2009, that his partner looked at 24-hour EKG from Holter monitor and it looks like normal sinus rhythm that has some slow beats, but that he did not feel comfortable prescribing florinef.  Appointment made for 1/6/2010 to see his cardiologist.) 12/21/09, PM:  Incontinent of stool in underwear because he could not make it to the bathroom on time.  This is unusual because he has never had an accident, either involving either urine or stool, from the day he was toilet trained.  Myoclonic jerks reappeared again.  12/28/2009:  2:15 PM:  Seen by pediatrician again for continuing dizziness, walking like a drunk, sleepiness, and myoclonic jerks that persist.  Neurologist consult ordered, but we were told the office will set this up and call us when appointment was made.  Diagnosis:  myoclonic jerks.  8:52 PM:  Woke up out of bed and stated "I'm boiling inside."  Temperature 98.1 rectally, 97.0 orally, and 95.7 axillary.  No signs of sweating.  Water given to drink. 12/29/2009, 11:02 AM:  Had what appeared to be ataxic gait; it was so severe that he could not walk independently.  He would fall unless someone held him or he held onto walls for every step.  Unable to walk heel-to-toe forward or backward, had a positive Romberg test, unable to hop on one foot, and could not stand unassisted without losing his balance.  11:14 AM:  I reported event on phone VAERS system.  1:20 PM:  Dizziness gone.  I reported problem to pediatrician's office because pt.'s ataxic gait did not disappear.  Nurse said office would call back.  3:50 PM:  Nurse called from pediatrician's office and said pediatrician had gone home for the day, that pediatrician's partner felt pt.'s problem was not acute, but that his pediatrician should be made aware of it first thing in the morning and so his chart will be put on her desk for her to look at first thing in the morning.  Awaiting appointment for neurologic consult.  Pt. denies dizziness but says parietal headache persist.  Denies pins-and-needles sensation but says left knee is numb.  Sensations to thighs, lower legs, and feet grossly intact. 12/30/2009:  9:39 AM:  While pt. was playing computer game, I secretly observe him and notice his back twists and has spasms and his legs frequently move incessantly and jerks at times.  I ask him if he is doing this on purpose and he says no.  10:51 A.M.:  Pt. walking normally, denies headache, dizziness, numbness, or feeling like burning up inside.  11:40 AM:  Pt. eating lunch.  Suddenly, myoclonic jerks appear and last throughout his lunch.  1:08 PM:  Pt. walks and runs normally and denies headache, dizziness, or feeling like he is burning up inside.  No myoclonic jerks.  Apical pulse still irregularly irregular, 87 beats per minute, which is back to his normal baseline.  3:15 PM:  Seen by pediatrician at the request of her office.  Informed pediatrician of pt.'s sudden improvement and of myoclonic jerks at lunch and persisting irregular heart rate that has returned to baseline rate.  Pediatrician's exam finds nothing grossly abnormal but plan is to check up on and follow through with neurologic consult in case something was missed. Pt.'s coughing is only occasional since 12/18/2009, without intractable spells. Has had no fever after 12/14/2009.  Intermittent dizziness from 12/08/2009 through 12/30/2009; no dizziness on 12/31/2009.  Intermittent parietal headache; time of onset was some time after 12/08/2009 and it has not recurred since 12/30/2009; one day after 12/08/2009 (I can't recall exact date), pt. also complained of left temporal headache upon waking up in the morning; temporal headache occurred only this one time.  Also complained of nausea and vomiting occasionally after 12/08/2009; I can't recall when he stopped complaining of this. 12/31/2009:  Feeling of being hot inside, sleepiness, and tiredness came back.  Irregularly irregular heart rate reappeared, 61 beats per minute,below his usual baseline.