Age: 16.0
Sex: F
Vaccine: FLU4, MNQ, FLU4, MNQ
Symptoms: Immediate post-injection reaction, Intraocular pressure increased, Loss of personal independence in daily activities, Magnetic resonance imaging head normal, Malaise
Clinical narrative: First week:  On 11/1/22 Patient had an annual wellness checkup (16 years old). Three health forms were signed showing Patient was in good health - State, Sports Physical, Driver?s Permit. Immediately, following the exam, Patient received 2 vaccinations.  Patient was seated on table in room and collapsed as a ?dead weight? in the nurse?s arms. She believes it was immediately after meningococcal and just prior to flu shot being given. The nurse laid her down on the table on her right side. Her eyes were wide open, pupils dilated, but she was unresponsive (estimated time 30 sec or less). She came to suddenly, slightly disoriented- asked nurse/mom if she had a seizure. The nurse checked her legs to see if they were shaking- they weren?t and told Patient she didn?t think she had a seizure. The nurse repeatedly stated ?That was weird. I never saw anyone jolt up like that.? patient was groggy but able to communicate. When asked why she thought she had a seizure, she stated that she wished she knew what a seizure felt like because what happened is how she thought a seizure must feel. She felt like ?my brain was shaking.? Later on, she stated that she felt like ?a train went through my head.?  Also said, ?it hurt my head.?  Patient and mom remained at the office for another 1+ hours until she felt okay enough to go home.   11/2-11/3 Patient did not feel well. Fatigued. Head was bothering her. Slightly elevated temperature on 11/2. Did not go to school but was able to complete some schoolwork in her room with rest/breaks.  11/3- Mom called pediatrician?s office concerned that Patient should be checked. Pediatrician returned call and stated that it sounded like typical vasovagal episode and she would be fine. Patient was up moving around a little more that evening. 11/4- Patient did not feel great decided to ?push through? and went to school because she didn?t want to fall behind. Shortly after arriving, the lights/noise in the classroom caused ?spinning? in head. Went to nurse?s office to lie down. Was sent home from school.  Mom called pediatrician?s office and was told to check her blood pressure (approx. 105/65). Office told mom to take Patient to ER for blood pressure check/fluids. Went to ER- received fluids, had normal EKG, normal bloodwork. Sent home to rest. (Walked in from parking lot; unable to walk back to car- had to get picked up at door). 11/6- Called pediatrician?s office again as Patient's symptoms had been worsening all weekend; Told to return to ER; symptoms had worsened-sleeping a lot; head pressure and ?spinning? when awake; unable to handle light/noise; ?head groggy, out of it,? ?can?t think clearly,? poor appetite but drinking; trouble focusing on what she sees; hard to ?process? everything; had normal bloodwork, normal EKG, normal CTscan of head; dr stated she likely needs more testing (MRI, EEG) but can?t be done at ER; instructed to follow up with pediatrician?s office early next morning; wrote note excusing Patient from school until cleared by pediatrician?s office; had to be wheeled out to car 11/7- Returned to pediatrician?s office- blood pressure checked again- normal. Pediatrician wrote script for EEG and gave mom list of cardiologists and neurologists.  11/8- EEG completed (results normal)- symptoms very bad this evening- had to lie in dark room with head down from 6pm till morning  Symptoms progressed over first week-   they cycle and some are worse sometimes than others but overall very little has changed. Her ability to function in daily life independently (even within the household) is minimal.  Although she often feels very foggy and unable to think too deeply, her speech/language is good/clear. Has felt unwell every day- no normal days since vaccination ; some symptoms are worse sometimes than others;  functional independent daily living skills are very limited due to her symptoms Symptoms include but are not limited to: Feels like ?brain cannot keep up with body?- everything is more difficult than it should be; information overload for her senses all the time  Difficulty concentrating Brain fog Extreme fatigue Brain feels totally overloaded- more stimuli makes it worse; visual/sound/motion Everything takes significant cognitive effort- cannot multitask or handle multiple stimuli Cannot tolerate much movement of head- usually sits with head supported  Noise in ear (whooshing/pulsating) with movement Hot/sweaty when she should not be- (in tank top in Deceember) Feet/toes are extremely cold almost all the time Tension headache- pressure wrapping around head like a band squeezing Jaw pressure pain- has gotten worse over time- went from pressure, to feeling like a weight on jaw to popping and locking- orthodontist made a night guard for her in January to keep jaw from locking- she has to wear it even during the day sometimes Spinning/dizziness- this is in head- not objects around her;  Nausea Pulsating pressure in head back strong feeling of pulse in body  sore neck/base of head Motion sickness Visual symptoms: ? Cannot tolerate dilation of eyes- dilated 12/18- unable to open eyes for 12 hrs and had 48 hours of migraine-like symptoms; light/glare symptoms even worse for weeks after Visual acuity, optic nerve, retina reported to be normal; eye pressure-except mildly increased pressure in left eye on 12/18-  but extreme eye strain- cannot focus eyes on objects for a sustained period of time; cannot read more than a sentence or so without extreme difficulty; cannot look at phone, TV, computer screen even with glasses The?busier? what she has to look at, the worse it is Prescribed prism glasses for convergence insufficiency on 12/1 Prescribed 2nd pair of glassed for convergence insufficiency, vertical heterophoria on 1/11, mild astigmatism, mild near-sightedness Pupils often large- they do constrict sometimes, but not as they would prior- (This has improved and is getting more close to normal) Severe light sensitivity- inside/outside; even with sunglasses; lights brighter than they should be Eyes not working together- cannot focus  Difficulty with glare- sees glare on things Shaky, hazy, vision Extreme difficulty focusing eyes on objects Little/no depth perception Sits/lies with head tilt to right Cannot focus on object for long; looking to another object is difficult Sees nose Left eye- hard to look to the side Eye on side of head tilted downward sees warmer colors than higher eye Harder to look at black and white objects  A more complete timeline is available going from 11/1 to today (2/22/2023)