Age: 7.0
Sex: M
Vaccine: FLUN4, FLUN4, FLUN4
Symptoms: CSF neutrophil count increased, CSF protein increased, CSF white blood cell count increased, Coma, Computerised tomogram head normal
Clinical narrative: Timeline of events: 10-14-15 FLUMIST 4:00 pm. 10-15-15 patient fever 100.5 missed soccer and school. 10-16-15 Didn't take temperature, but didn't seem to have a fever, but had swollen eyes. Thought it was allergies. Gave patient Motrin and Benadryl before bed. 10-17-15 patient lethargic for soccer game. Not eating much over the weekend. 10-19-15 (Monday) patient had swollen eyes. Gave him Zyrtec before school. Patient laid on the couch after school. Temperature of 101.3.  10-20-15 (Tuesday) patient started throwing up in the middle of the night. Fevers and throwing up continued on the Thursday. Had swollen lymph nodes today. 10-22-2015 Thursday. Patient had a fever of 104.9 F. He said, "Cut my head off. It's going to explode." Took patient to Pediatrician. He barely walked in. Strep tested positive. Started amoxicillin right away. 10-23-15 Friday. Amoxicillin didn't work. Fever persisted. Throwing up slowed down. Patient asked me to carry him to the bathroom or he will crawl. I took him to the bathroom, and he couldn't stand. 3:30 pm After I picked up siblings, patient was laying in his pee (blue sweat pants). He said he didn't pee. 3:50 pm took him back for Dr. this time. She said he has to go to the hospital. I had to carry him in. She sat him up and he threw up. (Pressure in the head). Then, he peed when he sat up. 5:15 pm in the PedsER. Patient is appropriate at first, just in pain. "Cut my head off. Cut my leg off." He can't understand to pee in urinal. Over the next 5 hours he gets x-ray, LP, blood work. WBC elevated. LP looks like viral meningitis. Elevated WBC's and elevated protein. Dr. (In charge of the PICU) admitted him. 10-24-15 Another Dr. saw him. Explained everything. Patient was thrashing and more uncomfortable. Noticed that when he had fevers he was more disoriented. Gave him Tyenol and Motrin around the clock and switched this to Toradal. He was still talking, just irritated. 10-25-15 Sunday Calmer, but more comatose state. Neurologist came and saw him. Recommended EEG. After started having Chain Stroke breathing. Ventilator placed outside the room. Dilantin given as a precaution to possible seizures. Occupational and physical therapy started. 10 pm someone said he loved him and patient said, "I love you too, Dad." 10-26-15 EEG done. PICC line placed in Right brachial. NG weighted placed in left nare. Patient a lot more alert today for longer periods. Still doesn't talk much. I brushed his teeth and kissed him. He said, "Could you please just stop." I did it again and laughed with tears of joy, and he said, "Just be quiet." Family came in the evening. Infectious disease Dr. came. He said he believed this was encephalitis from the FLUMIST. I completely agree. EEG came back negative, except for encephalitis features. He just needs time. Occupational and physical therapy. 10-27-15 Only said, "Hi, mom" today. Weaker than yesterday. Speech not as clear as yesterday. Three Dr's. saw him today. Occupational and physical therapy.