Age: 6.0
Sex: M
Vaccine: FLU3
Symptoms: Dyskinesia, Headache, Hypotonia, Laboratory test abnormal, Nausea
Clinical narrative: Delirium, headaches, nausea and vomiting app. 26 hrs after vaccine given. Admitting diagnoses: episode of dissociation, seizure, low grade fever, possible reaction to the influenza vaccine. Discharge diagnoses: chronic seizure activity times five minutes at home, likely viral syndrome, possible influenza vaccine reaction. The pt is a previously well 6 year old male who received flu shot on 11/5/03. On the morning of 11/6/03 complained of a headache and stomachache. The pt was sent to home and sent back home from school an hour later. The pt vomited times three at home and in between very sleepy. The pt came downstairs in the afternoon and became acutely confused while sitting next to mom. He could not recognize his sister, his mom, or a glass of water. He simply said "I don't know" and shrug his shoulders while staring off. The pt then became limp and unresponsive and the mom laid him down and called 911. By the time the paramedics arrived, the child had jerking motions of his arms and body which mom estimates to have occurred for approximately five minutes. The paramedics told the mom that he was having a seizure. They brought him to ER for further evaluation and treatment. His temp at the time the paramedics arriving was 99.8 and there was confusion as to whether his temp in the child ER was 100.3 or 103. The pt remained unresponsive for the next hour to hours while at ER. CT scan of the head was done which was normal. WBC was 10.7, segs 93, no bands, 4 lymphocytes, 3 monocytes, hemoglobin 12.5, platelet count 315,000, electrolytes with sodium 134, potassium 4.1, chloride 100, bicarb 22, glucose 148, bun 13, creatinine 0.6, total protein 7.2, albumin 4, globulin 3.2, calcium 10, bilirubin 0.2, sgot 22, sgpt 34, alk phos 282, urinalysis is yellow, cloudy, specific gravity 1.020, ph 6.5, dipstick negative except for blood 1+ and 37 red cells, 0-2 white cells, urate crystals. This was a catheter specimen. Lumbar puncture was also done in the ER and spinal fluid showed 7 RBC's in the first tube, 2 in the fourth tube, glucose, 88, protein 25.6, gram stain was not reported and differential was not sent. Mom denies the possibility of the child having gotten into any medications or toxic substances. The pt denies having swallowed anything. The pt was observed overnight and by the time he came to medical center he was back to his normal state. He remained febrile through the night. There were no further episodes of vomiting. There are no episodes of diarrhea. The case was discussed with Dr. of neurology who was covering for doctor of pediatric neurology. We felt it appropriate to refer the child for evaluation. Also ordered a sleep deprived EEG in two weeks. We did not feel it necessary to start the child on antiepileptic medications at this time. There is no family history of seizures or febrile seizures. The child never had seizure activity in the past. The pt did receive a dose of Rocephin in the ER, but the antibiotics were not continued during his hospitalization. The pt also has a history of asthma which remained stable during his hospitalization. The follow up received on 12/24/03 states pt vomited x 3 at home later 1st confused, 2nd limp, and 3rd jerking. Unresponsive. Date of first clinic/ER/hospital visit for the reported seizure: 11/6/03. Diagnosis made by a neurologist. Seizure activity x 5 minute likely viral syndrome of poss flu vax reaction.