Age: 18.0
Sex: M
Vaccine: MNQ, FLU3, MNQ, FLU3, MNQ
Symptoms: Headache, Immunoglobulins increased, Pain, Paraesthesia, Peripheral coldness
Clinical narrative: Initial report received from the Centers for Disease Control and Prevention (VAERS numbers 247539 and 247440) on 22/Nov/2005. An 18 year old male patient received a dose of Menactra, lot number U1821AA, in the right arm and a dose of Fluzone SV 2005-2005 USP in the right arm on 29/Oct/2005 at 11:00 am. Eight days later the patient experienced chills, body aches, headache, fever and trouble urinating. The following day he had difficulty walking (also reported as inability to walk balanced). He was seen in the emergency room and also complained of a cold and tingling sensation in his feet and legs. A catheter was inserted and the patient was prescribed antibiotics. On 09/Nov/2005, the patient had much difficulty walking and fell over. He returned to the emergency room and was transferred to a clinic. He was treated with ceftriaxone and Acyclovir. The admission note state that the impression was "probably ADE (acute disseminated encephalopathy) likely secondary to Menactra." The patient had a high cervical sensory level and bilateral pyramidal signs. He had an abnormal MRI, which showed bilateral patchy white matter signals. The patient's recovery status is unknown. This information had previously been submitted to the FDA. Follow-up information received on 30/Nov/2005 from the Centers for Disease Control and Prevention. Admission date to the hospital was 09/Nov/20052. The patient was transferred for rehabilitation on 15/Nov/2005. At that time, a lack of sensation below the shoulder remained. At the time of this report, the patient had not recovered. Follow-up information received on 08/Dec/2005 from the consulting neurologist. It was reported that the patient had a viral upper respiratory infection about two weeks prior to his admission to the hospital. Following the onset of the reported symptoms of ADEM. he was admitted to the hospital on 09/Nov/205. The principal diagnosis was acute disseminating encephalopathy.  A lumbar puncture on 10/Nov/2005 showed a red blood cell count of 13, white blood cell count of 99, protein 84, glucose 99, elevated IgG 8.4, albumin 58.1. A gram stain was negative and culture of the CSF showed no growth. PCR for herpes simplex was negative. Empiric therapy of Acyclovir and ceftriaxone were started upon admission, but were discontinued upon receiving the laboratory work. The patient was treated with a four day course of IV Solu-Medrol, which resulted in a clinical and neurological improvement. Physical and occupational therapies were also initiated,and it was noted that the patient had good progression of retaining lower extremity strength. An ophthalmologic examination confirmed that the retinal and optic nerves were not involved. On 14/Nov/2005, the IV Solu-Medrol was discontinued and oral prednisone therapy was begun. The patient continued to require physical and occupational therapy to regain strength and control. He was, however, stooling and voiding spontaneously. On 15/Nov/2005, the patient was transferred to a rehabilitation hospital in good condition.