Age: 20.0
Sex: M
Vaccine: FLUN3, HEPAB, MMR, MNQ, PPV
Symptoms: CSF white blood cell count, CSF white blood cell count negative, Chest X-ray normal, Computerised tomogram abnormal, Computerised tomogram head
Clinical narrative: Initial report received from the Center for Disease Control on 08 September 2009 and follow-up information on 16 September 2009 (VAERS number 350576). A healthy 20-year-old male patient, who had no known drug allergies, and who was in excellent health prior to service entry in May 2009, subsequently received multiple vaccines on 13 May 2009 that included a intramuscular left arm injection on MENACTRA (lot number U2843AA); an intranasal dose of FLUMIST (lot number U24791DA, manufacturer Medimmune); a subcutaneous right arm injection of MMR II (lot number 0008Y, manufacturer Merck); an intramuscular right arm injection of PNEUMOVAX (lot number 1679U), manufacturer Merck; and a intramuscular left arm injection of TWINRIX (Lot number AHABB162AA), manufacturer GlaxoSmithKline). The patient did not note any specific reactions at the vaccination sites; however, on 28 May 2009 the patient reported for evaluation of upper respiratory infection (URI) symptoms. He was treated with MUCINEX, TYLENOL and SUDAFED. At that time, the patient reported multiple sick contacts with similar upper respiratory infection symptoms. Four days later, on 01 June 2009, the patient was seen and diagnosed with bronchitis and prescribed ZITHROMAX. The following day (02/Jun/2009), the patient awoke with tingling, numbness and weakness of his entire body, except for his head and neck. The patient was seen for follow-up of bronchitis and he was placed on 72 hours quarters. Per the reporter, there was no mention of the numbness or weakness in the clinic note. Three days later (05/Jun/2009), the patient returned with complaint of falling "to his knees"...can't feel legs, feet, shins, hands and fingers." At that time, the upper respiratory infection symptoms had significantly improved. The patient had no bowel or bladder symptoms, or visual changes and the patient was released to duty. Three days later (08/Jun/2009), the patient was seen in the clinic for body numbness. His gait was "off balance", he had ataxia and difficulty with balance. He required increased concentration to get dressed as buttons and laces were hard to manipulate. He also reported that he was unable to feel when he plants his feet down. He had difficulty with writing and fine manipulative tasks. He was placed on 48 hour quarters. On 10/Jun/2009 the patient returned complaining of body numbness for ten days and was referred to the emergency room after 'PCM" consulted with neurology. The following day, neurology evaluated the patient and examination (HPI) noted a 10 day history of numbness of all extremities and entire body with subsequently generalized weakness, gait difficulty, soreness of calves and thighs. Examination revealed slightly diminished strength of Upper and lower extremity (4/5), with 3+/5 strength of distal muscle groups. The patient was unable to walk a straight line, with abnormal heel walking and diminished DTRs in UEs and absent DTRs in LEs. The patient complained of significant numbness in fingers and toes with generalized numbness of the body below the neck. He stumbled when he walked and had arthralgias of the knees and myalgias in the thighs and calves. He was easily fatigued and had anorexia. The patient had upper respiratory infection symptoms such as cough and sore throat. He had bilateral upper extremity and lower extremity paresthesias, absent DTRs in bilateral lower extremities, decreased DTRs in bilateral upper extremities, weakness of the bilateral upper and lower extremities and presence of CSF albuminocytologic dissociation (slightly elevated CSF protein with absent pleocytosis). The patient was diagnosed with GBS (GUILLAIN BARRE syndrome) and treated with IVIG times 5 days. The patient was then transferred to inpatient rehabilitation facility. Per the reporter, the date of service was 11 Jun3 2009 to 16 June 2009. The discharged diagnosis was GUILLAIN BARRE Syndrome. From the additional information received on 16 September 2009 from the CDC, this case was evaluated by the network and determined to meet the proposed case definition of GUILLAIN-BARRE Syndrome, with a level 1 of diagnosis certainty. Documents held by sender: None. THIS IS A FOLLOW-UP TO A PREVIOUSLY SUBMITTED VAERS report 350576. Patient is on Temp Disability Retirement List with disability evaluation of 70%. Symptom improvement plateaued around Nov 2009 - still has some neuropathic pain and extremity weakness. No active therapy or treatment at present.