Age: 12.0
Sex: M
Vaccine: HPV9
Symptoms: Nausea, Proctalgia, Stress, Throat tightness, Vomiting
Clinical narrative: Pt was given GARDASIL-9 vaccine 9-6-16. Came back to our office 9-8-16 with continuing nausea, vomiting, dizziness. Patient is a 12 year old male. Mother reports patient has c/o nausea and dizziness for 2 days, and child vomited yesterday. She said she's not sure if this is related to child's s/s, but patient also got a GARDASIL shot that day 9/6/16. Later patient told his mother he has had the nausea since Sunday 9/4/16 (2 days prior). Mother said had she known patient was not feeling well they would have waited on the GARDASIL. He did not mention his nausea until after shot was given. He also stood up to do chicken arms right after shot was given, despite nurse telling him to remain seated. For the past 2 days after the shot was given, he has had dizziness. This is variable. It never occurs when he is supine. It can occur with sitting and especially more often when standing. The longer he stands, the dizzier and more nauseous he gets. This has resulted in vomiting 2-3 times/day since shot was given, last emesis this AM. He has noticed mild alternating chills/sweats for past 2 days since shot, but no fever. He has been back to school since last week. First month is always stressful and tends to fuel his anxiety disorder. Anxiety can make him nauseous but has never made him vomit. He admits that anxiety may be playing a mild role this week with back to school, but he also feels there is true nausea. He did travel 3 weeks ago. They returned 1 week prior to school start 8/29. He did have mild nausea with travel in car, something he never had before. He attributes this to using ipad in the car and refuses to discuss it further. He tends to constipation with infrequent, large, hard stools in past 2-3 months. He does sometimes have anal and abdominal pain with passage of stool. He treats/prevents this with 1-2 snacks per of salted cucumbers. Mother plans to treat his nausea and constipation today with sausages and fatty food. She tried meatballs last night, but that made him vomit. He has had mild cough for past 5+ months. This cough occurs most often when he is eating ice cream and relaxed, but can occur at any time. He is very dairy intolerant. The only dairy he gets is ice cream. It is his way to relax and his relaxation time. He has not been eating as much ice cream all summer because his stress has been lower. However, with back to school stress for past 10-14 days, he has increased ice cream to qd-bid. No taste perversion. Cough is not productive. He feels like his throat is closing up. When he coughs, it opens back up again. He coughs more when parents tell him not to. He denies congestion or RN. He does sneeze occasionally. For months, his eyes will wander when parents are talking to him. His father notices this a lot, but mother does not seem to experience it as much. During our 30+ minute encounter, his eyes only wandered a few times in a normal way for wandering attention of his age. Once mother brings this concern up at end of encounter, his eyes begin wandering frequently as 5 times in 30 seconds or more. Patient accompanied by mother. No fever.