Age: 15.0
Sex: F
Vaccine: HEP, MMR, HEP, MMR
Symptoms: Convulsion, Syncope
Clinical narrative: A 15 year old white female who on 08/18/01 at approximately 13:20 was vaccinated with the 2nd dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live, SQ in the right arm at a free vaccine clinic at a grocery store. Concomitant therapy that day included the 1st dose of hepatitis b vaccine, recomb (Engerix-B) IM in the right deltoid. Post vaccination at approximately 13:20, the patient returned to her car in the parking lot, where her family members stated that she had a seizure and fainted. When the nurse ran out to the car, the patient was in the back seat of the car alert and oriented with a pulse rate of 70. The emergency medical technicians were called to the scene and she was transported to the hospital for evaluation for a grandmal seizure. It was noted that the patient's family reported that she lost consciousness and had tonic clonic activity of all of her extremities and was unresponsive. The family stated that the episode lasted less than five minutes and there was a short postictal period approximately two minutes, after which time the patient regained normal mental status and complained of no headache, no weakness or numbness. There were no other complaints. The patient was afebrile. It was noted upon physical exam in the hospital emergency room, the patient's vital signs were stable and she was afebrile. There was a small abrasion (2x2 cm) to the lateral aspect of the left ankle, otherwise the exam was unremarkable. There was no evidence of oral trauma and the patient did not have incontinence. Neurologically the patient was noted to be nofocal, strength 5/5 in all the major muscle groups distally and coordination and cerebellar function were intact. The patient's gait was normal. The computed axial tomography (CAT) scan of the brain without contrast was negative and there was no evidence of intracranial pathology. It was also noted that a Chiari I malformation was not excluded. The cardiovascular exam was reported as regular rate and rhythm with no murmurs, rubs or gallops. An electrocardiogram showed normal sinus rhythm with a rate of 80. Pulmonary exam revealed full and equal breath sounds bilaterally. Abdominal exam reported a soft, nondistended abdomen with normoactive bowel sounds. The patient's fingerstick for glucose upon arrival was 88. Laboratory findings included: platelet 279; WBC 6.1; RBC 4.77; Hemoglobin 12.9; Hematocrit 37.4; MCV78; MCH 27.1; MCHC 34.5; RDW 13.9; polys % auto 70; lymphs % auto 24; mono % auto 6; polys ABS 04.3; lymphs ABS 1.4; monos ABS 0.4; EOS ABS <0.7; Basos ABS <0.2; sodium 137; potassium 3.7; chloride 102; CO2 28; urea 11; creatine 0.6; glucose 100; anion gap 7; calcium 9.1; acetaminophen 3.8; salicylate 1; urine toxicology negative and urine beta-human chorionic gonadotropin negative. Urinalysis: color yellow, appearance hazy, PH 9.5, specific gravity 1.010 trace protein, WBC 0-2/HPF, squamous epi 1+, trans epi occasional, bacteria occasional. mucous 1+/HPF. The patient was clinically stable in the emergency dept. A pediatric neurologist reviewed the patient's case and determined that the patient could receive follow-up such as an MRI and EEG as an outpatient for further work-up for possible seizure disorder. The patient was to follow-up with the pediatric neurologist within the next three days and to follow strict seizure precautions. The emergency room physician listed the impression of the event as a seizure and the patient was discharged in good condition. It was noted that the patient was considered as recovered. Info from a registered nurse noted that on an unspecified date the patient had "starring" after the 1st dose of MMR "maybe". Upon internal review, the patient's seizure / tonic clonic activity was considered to be an other important medical event.