Age: 21.0
Sex: M
Vaccine: FLU4, MENB
Symptoms: Red blood cell count decreased, Red blood cell morphology normal, Red cell distribution width normal, White blood cell count normal
Clinical narrative: The initial case was missing the following minimum criteria: Unspecified number of patients. Upon receipt of follow-up information on 15Dec2016, this case now contains all required information to be considered valid. This is a spontaneous report from a contactable nurse via sales representative and then from the same nurse only. A 21-year-old male patient received TRUMEMBA; (Batch/Lot: N16808; Exp: 30Jul2017) at 0.5 ml single intramuscular in left deltoid as prevention of meningo B on 29Sep2016 at 16:30. On the same day he received also the tenth dose of influenza vaccine quadrivalent (Manufacturer: Sanofi; Lot #: U1678AB) intramuscular in right deltoid for immunization. Patient previously received nine doses of influenza vaccine, given annually with no problems. Medical history included anxiety, major depressive disorder and attention deficit/hyperactivity disorder (ADHD) all ongoing. Concomitant medications included DEXTROAMPHETAMINE from 26Sep (unspecified year) for ADHD at 5mg 3x/day. On an unspecified date, after receiving suspect vaccines, the patient developed body aches and severe back pain which caused a severe burning pain and numbness of his legs. Patient presented with worsening, persistent and burning low back pain for 3 days. He described pain as stinging and stated that it radiated down the backs of both his legs. Pain scale was 8/10. He also began to have myalgias and chills. He noted nausea and weakness/tingling in his bilateral lower extremity. He denied fevers. Patient referred to emergency department (ED) but was not admitted. On 03Oct2016 at 22:45 CSF glucose 59; CSF-XA: None; Full blood count (CRBC): 1675 and 23;  CSF lymphocyte count % (%CLYMPH) 40 and 60; ATYPS%-CSF: 0; CSF monocyte count % (%CMONOS) 10 and 24; Eosinophil count % (%CEOS): 0; Band neutrophil count % (%CBANDS): 0; CSF neutrophil count % (%CNEUT) 16 and 50; %CUNCLASS: 0; CNRBC: 0; Albumin CSF (ALBCSF): 18.2; CSF immunoglobulin (IGGCSF) 2.0. On 04Oct2016 at 00:20: Na at 138;K 3.6; Cl 99; CO2: 26; BUN 12; creatine (CRE) 0.93, anion: 13; Ca: 9.7. Hematology on 04Oct2016 at 00:20 showed White blood cell count (WBC) 5.91; Red blood cell count (RBC) 4.44; Haemoglobin (HGB) 13.9; Haematocrit  (HCT) 40.8; Mean cell volume (MCV) 91.9; Mean cell haemoglobin (MCH) 31.3; Platelet count (PLT) 253; Mean platelet volume (MPV) 10.4; Red cell distribution width (RDW): 11.8; Neutrophil count % (%Neut) 61.6; Lymphocyte count % (%Lymph) 27.2; Monocyte count % (%Mono) 8.5; Eosinophil count % (%EOS): 1.4; Basophil count % (%Baso): 1.0; Neutrophil count (ANEUT) 3.64; Lymphocyte count  (ALYMPH) 1.61; Monocyte count (AMONS) 0.50; Eosinophil count (AEOSN) 0.08; Basophil count (ABASOP): 0.06; Nucleated red cells (NRBC-ABS) 0.00. Lumbar puncture on 04Oct2016 at 3:05 AM was done with local anesthetic lidocaine 1% without epinephrine to evaluate infection. Microbiology spinal fluid was done on an unknown date; Gram stain on unknown date showed rare polys, rare mononuclear cells, rare red blood cells, no organisms seen, no growth. All labs including protein level (LP) were normal. The events myalgias and chills resolved in one day, the outcome of the other events was unknown. Final diagnoses were back pain and muscle pain.