Age: 18.0
Sex: F
Vaccine: MNQ, MNQ
Symptoms: Myasthenic syndrome, Nausea, Protein total decreased, Red blood cell count decreased, Saliva altered
Clinical narrative: Initial report received on 22Sep05. An 18 yr old female pt with a medical history of ulcerative colitis, had received a first dose of Menactra, lot number U1658AA, administered on 19Jul05. The route and site of administration were not reported. 29 days post vaccination, on 17Aug05, the pt experienced a severe headache and was seen in the emergency dept. She had no complaint of neck stiffness. A CT scan of the head was negative and she was discharged home on Motrin. On 19Aug05, the pt experienced tenderness in her calves and found it difficult to stand on her toes. She also had some feeling of foot weakness. By the morning of 20Aug05, the pt was unable to walk. She denied any visual changes, had no trouble talking and was handling her oral secretions, but she did notice some weakness in her hands. She had no complaint of back pain. She had no travel history. The pt was admitted to the hospital  on 20Aug05 with the presumptive diagnosis of Guillian Barre syndrome. Her evaluation included an ultrasound of her bilateral lower extremities, which showed no evidence of a deep vein thrombosis. She had a lumbar puncture where the first and the last tubes were sent for fill counts. The CSF/WBC was 25 and then 1. RBC 38, then 0. Protein 30 and then 23 and a glucose of 60. She had negative inspiratory pressures of -60 and vital capacities were measured between  4.4 and 5.6 liters. She was administered intravenous immunoglobulins on 20Aug05 and 21Aug05 (each dose 400mg/kg). On 22Aug05, the pt was transferred to another hospital at parental request and concern of a deteriorating neurologic function and was admitted to the pediatric intensive care unit.  Her vital signs were stable and she was breathing room air with a SPO2 of 99%. Her negative inspiration pressure was -40. Her Glasgow coma scale was 15 and she was awake, alert and interactive. Upon physical examination, it was noted that she had normal differentiation of hot and cold and soft and sharp. She was weak in the hands and forearms. She also had weakness in her feel, especially on dorsiflexion. She was able to lift her legs off the bed and hold her arms horizontally without a pronator drift. Her weakness was predominantly distal. She was continued on intravenous immunoglobulins and Zantac. On 23Aug05 it was noted that the pt continued to have a significant headache, as well as nausea and vomiting. Her respiratory status was continually monitored and her negative inspiratory pressure overnight ranged between 46-60. She continued to complain of weakness in her lower extremities, especially flexion more than extension. She had no abnormalities of sensation or proprioception. A physical examination showed no evidence of autonomic hyperreflexia. Her vital signs remained stable and she had no respiratory distress. Her nausea improved considerably overnight with the administration of Zofran. Her lower extremities continued to feel worse and she noted further weakness. Her hand grasp was poor. Electromyography testing on 22Aug05 showed deficits consistent with a pure motor lesion. An MRI of her lumbar spine was normal. She received a fourth dose of intravenous immunoglobulins overnight. Her respiratory status remained stable. Neurological examination was notable for worsening bilateral lower extremity weakness with a strength of 3/5 and continued poor hand grasp. On 25Aug05, it was noted that the pt had completed a five day course of IV immunoglobulins and had not evolved to severe dysautonomia. Her neuromuscular weakness was improving. Her negative inspiratory force on respiratory parameters was -50 and her vital capacity was 1.3 liters. Her oxygen saturation was 97 to 100% and her Glasgow coma scale 15. She was scheduled for consultations with occupational therapy, physical therapy, speech and rehabilitation therapy and was ambulating slowly with assistance only. It was reported on the form completed by the vaccine provider on 21Sep05, and which was received through the CDC that the pt recovered from the events. This information has previously been reported to VAERS.