Age: 16.0
Sex: M
Vaccine: FLU4, HEPA, HPV9, MNQ
Symptoms: Activities of daily living impaired, Back pain, Blood creatine phosphokinase increased, Blood thyroid stimulating hormone increased, C-reactive protein normal
Clinical narrative: On 10/10/2016, was seen for 16 year physical - received Hepatitis A, HPV, MENACTRA, and Flu vaccines. On 10/11/2016, was seen at ER with RT flank pain. On 10/14/2016, F/u ER: Seen w/ RT flank pain on 10/11. Pt felt warm and was sweating. KUB showed stool and no other significant finding. UA was normal. Sent home on Miralax and Colace. Child denied constipation. Had runny stool since taking medication. Still had pain. No vomiting or urinary sxs at that time. CBC performed in the office was Normal, UA in the office was also normal. CBC/UA reassuring, but child was still in pain, sxs had not changed, waking him up at night. Referred to ER for further evaluation. On 10/14/2016, patient was admitted - has had extensive workup including blood test, urine test, and ultrasound. On 10/19/2016, F/u Admission (10/14/2016 to 10/16/2016): was admitted for RT flank pain. All lab results normal (CBC, CMP, CRP, ESR, CPK, GGT, Lipase, and UA) CT scan, US, Xray of the Pelvis were also performed and revealed no abnormality. Had Neuro, Pain, and PT consultations while hospitalized, unable to determine etiology. Was sent home on muscle relaxant, Motrin, and Lidocaine patch for symptomatic relief. Child still c/o pain, unable to sleep secondary to pain. No fever or urinary sxs. No limping, denies hip pain. Was referred to PT. Was advised to gradually wean off pain medication and muscle relaxant. To call if not better/worsening pain. On 10/31/2016: Pt unable to return to school, tried stopping muscle relaxant but pain returns, stays up all night with pain. No hip pain or urinary sxs. Hurts on RT side in flank on changing position. No vomiting or fever. No appetite. Just drinking fluids and smoothies. Ordered Creatine Kinase Total, CBC w/ Diff/Plate, Sed Rate, and UA. UA was within normal limits. CPK elevated, CBC, ESR and CMP normal.  Xray of the Lumbar spine was ordered, referred to Ortho for further evaluation. On 12/06/2016, F/u from ER 12/05/16 - SOB. Started having breathing problems at school the week before. Mom thought it was because of the brace he was wearing for Myositis so pt stopped wearing brace. Breathing problem did not get any better. Child was unable to catch his breath, went to ER day before. No cough or fever. Normal EKG. Child has been seeing Orthopedics, a brace was prescribed and Mobic was prescribed. Probable musculoskeletal pain VS GERD, reassure parent, advised to get CPK rechecked as recommended by Ortho. Repeat CPK was normal. On 12/9/16 the mother called the office and stated the patient was having chest pain to the touch and mother instructed the pt to take off the brace due to the chest pain. CXR was ordered. On 12/16/2016: F/u Normal CXR. Chest and back is hurting, it's hard for him to breathe and to take deep breaths. Unable to stay in school, has been there only for 3 hours all week. Barely able to stay awake, no appetite, food sometimes comes in his throat, very tired. Has been sleeping a lot, sxs are getting worse, RT flank pain still present. Parents think sxs are secondary to HPV vaccine. Parents requesting neurologist referral. Has been to Ortho, unable to find answer. Referred to as the child seems too drowsy. Seen in ER, had normal lab results except positive Mono (EBV within normal limits). TSH was borderline elevated with normal T4. Still very drowsy, barely able to keep his eyes open, c/o pain on changing position. Referred to Neurologist on mom's request. Mom requesting records to further pursue on HPV reaction. Copies of all labs given to mom.