Age: 12.0
Sex: M
Vaccine: MEN, TD, MEN, TD
Symptoms: Injection site inflammation, Muscular weakness, Myalgia, Myositis, Neck pain
Clinical narrative: Initial report received from a health care professional on 13/Oct/2005. A 12 year old male patient received a dose of Decavac, lot number U1215DA, and a dose of Menomune A/C/Y/W-135, lot number UE431AA, on 29/Jul/2005. Both vaccines were administered in the left deltoid and the route of administration was not reported. The patient was playing football and received an injury to his ribs and began to have chest pain two days later on 01/Oct/2005. He was seen in the physician's office on 03/Oct/2005 for complaints of chest pain with deep breathing. The pain radiated to his neck and could be aggravated with exercise. It was reported that the pain "feels like chest is tight, not real pain." The patient also reported that his legs felt very weak bilaterally. The leg weakness started on 01/Oct/2005. The patient had no loss of reflexes. Physical examination showed chest wall tenderness at the costovertebral angle, left greater than right, with no ecchymosis or deformity. No abnormality was noted in the strength of the patient's legs. The patient was diagnosed with costochondritis and muscle weakness and was treated with Naprosyn EC 375 every 12 hours for three days, then as needed. The patient was seen by the physician for a follow-up visit on 06/Oct/2005. At that time he still felt weak and had pain in his upper extremities, which was very atypical for him. He reported a "nasty headache" the previous day and his leg weakness had reoccurred. At the time of examination he reported that his neck and back ached. A review of systems was unremarkable with the exception of his chief complaints. His muscle strength was 5/5 for all groups tested and his muscle tone was normal. Testing of the cranial nerves revealed no deficits and his coordination was noted to be good. His deep tendon reflexes were normal. He was diagnosed with myalgia and myositis and started on Doxycycline 100mg, every 12 hours for ten days. A Lyme panel and chemistry panel were negative. It was also planned to check the patient's CPX, as well as Ehrlichiosis and Babesiosis titers. On 13/Oct/2005 the patient was again seen by the physician for follow-up. At that time he reported feeling much better and felt that the Doxycycline "really helped." A review of systems was normal. Cranial nerves II -XII were noted to be intact and his deep tendon reflexes were 2+/4+ bilaterally and symmetrical. A follow-up Lyme panel, CBC and sed rate were drawn. The patient did not have an EMG or lumbar puncture. He was to continue on Doxycycline. It was reported that the patient recovered from the events. It was noted during internal review of this case that the medical records forwarded by the physician's office on 17/Oct/2005 noted that the patient received Menactra, however the lot number provided (UE431AA) matched that of Menomune A/C/Y/W-135 single dose vial. The physician confirmed that she administered lot number UE431AA to both the patient and his sister and stated that she has only ever ordered Menactra. The physician's order history was verified with Medical Information Services. The physician's office received Menactra, lot number U17677AA on 15/Jul/2005 and Menactra, lot number U1783AA on 14/Sep/2005. Both lot number were for multi-dose packages. The physician reported to Medical Information Services that she did not reconstitute any vaccine, however, Menomune A/C/Y/W-135 is powder and is reconstituted with accompanying diluent. It was reported that the facility receives vaccine from the company, as well as through the state VFC program, but it was not determined whether Menomune A/C/Y/W-35 is available through VFC. Medical Information Services is completing an investigation. Follow-up information received from a physician on 08/Nov/2005. The patient was re-examined for symptoms of bilateral pain and weakness of the upper and lower extremities. Deep tendon reflexes were normal. It was the opinion of the physician that this did not represent Guillain-Barre Syndrome. The patient was referred to a neurologist. At the time of this report, the patient had not recovered. Follow-up information received from the neurologist on 21/Dec/2005. MRI of the cervical spine showed syringomyelia of C3-C7. The patient was referred to a neurosurgeon. (OMIC)