chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Nausea, Pain in extremity, Rash, Syncope, Weight decreased
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Abdominal pain, Activities of daily living impaired, Amnesia, Arthralgia, Asthenia
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Asthenopia, Bone pain, Brain scan normal, Burning sensation, Chest pain
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Computerised tomogram normal, Constipation, Contusion, Convulsion, Crying
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Disturbance in attention, Disturbance in attention, Dizziness, Dyspepsia, Dysuria
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Epstein-Barr virus infection, Fatigue, Feeling cold, Fibromyalgia, Gastrointestinal disorder
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Hyperaesthesia, Hypotension, Insomnia, Laboratory test normal, Loss of consciousness
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Lyme disease, Migraine, Muscle spasms, Muscle spasms, Nausea
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Pain in extremity, Pruritus, Rash, Rash generalised, Scan brain
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Scan brain, Sleep disorder, Somnolence, Speech disorder, Tinnitus
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 14.0
Sex: F
Vaccine: FLU3, HPV4, FLU3, HPV4
Symptoms: Visual impairment, Weight decreased, Weight decreased
Clinical narrative: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods.  7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871.  7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.
Age: 0.5
Sex: M
Vaccine: DTAP, HEP, MMR, VARCEL
Symptoms: Inappropriate schedule of drug administration
Clinical narrative: No reaction
Age: 1.5
Sex: M
Vaccine: DTAP, HEP, MMR, VARCEL
Symptoms: Pyrexia, Rash generalised
Clinical narrative: Pt came in w/ rash all over body on 6/19/09, pt also had low grade fever x 2 days.
Age: 2.0
Sex: F
Vaccine: PPV, VARCEL
Symptoms: Gait disturbance, Injection site pain, Pyrexia
Clinical narrative: Pain in left leg, high fever, refused to walk a.m. after injection given
Age: 14.0
Sex: M
Vaccine: MNQ
Symptoms: Epistaxis
Clinical narrative: starting having bloody noses at approx 1 am 6/26; has had 8 between then and 7:15 am 6/30. He has not had bloody noses before, and he has not been active since receiving the vaccine (no sports). Bloody noses mostly concentrated on left side, but fairly heavy bleeding. they are able to be stopped with pressure after 10 or so minutes. No accompanying fever, and the injection site is fine.
Age: 12.0
Sex: F
Vaccine: HPV4, MNQ, TDAP, VARCEL
Symptoms: Computerised tomogram normal, Crying, Ear pain, Fall, Head injury
Clinical narrative: Pt left clinic with mom approx 5 minutes after being seen in clinic ear pain at 2:30 pm and also received four immunizations including HPV (Gardasil), Tdap, Menactra and Varicella.  While waiting for valet to bring vehicle, pt told mom she felt nauseous and then fainted and fell backward, hitting her head on the sidewalk. Pt came back to clinic and was upset and crying and had a knot on the upper back portion of her head. The nurse practioner seeing the pt was notified and an RN performed a neuro check which was wnl and ice pack was applied before sending pt to have skull films performed. Pt returned to clinic and was observed for another 30 minutes before releasing to go home with mom. At 2:00 am, mom called triage line because pt was vomiting. Pt was advised to go to ER and did so where a CT Scan was performed which mom reports was WNL so they were sent home.
Age: 12.0
Sex: F
Vaccine: HPV4, MNQ, TDAP, VARCEL
Symptoms: Irritability, Nausea, Skull X-ray, Syncope, Vomiting
Clinical narrative: Pt left clinic with mom approx 5 minutes after being seen in clinic ear pain at 2:30 pm and also received four immunizations including HPV (Gardasil), Tdap, Menactra and Varicella.  While waiting for valet to bring vehicle, pt told mom she felt nauseous and then fainted and fell backward, hitting her head on the sidewalk. Pt came back to clinic and was upset and crying and had a knot on the upper back portion of her head. The nurse practioner seeing the pt was notified and an RN performed a neuro check which was wnl and ice pack was applied before sending pt to have skull films performed. Pt returned to clinic and was observed for another 30 minutes before releasing to go home with mom. At 2:00 am, mom called triage line because pt was vomiting. Pt was advised to go to ER and did so where a CT Scan was performed which mom reports was WNL so they were sent home.
Age: 20.0
Sex: F
Vaccine: HEP
Symptoms: Muscle spasms, Pharyngeal oedema, Pruritus, Vomiting
Clinical narrative: Pt called office to report approx 12 hours following vaccine administration she developed widespread, intense muscle spasms, vomitting, hands and feet itching, throat felt swollen but could breathe.
Age: 51.0
Sex: M
Vaccine: HEPA
Symptoms: Arthralgia, Chills, Flushing, Headache, Joint effusion
Clinical narrative: Vaccine administered 6-22-09, 2nd dose of Hepatitis A vacccine. That evening headache, myalgias, chills, low grade fever 99.3. Evening of 6-25-09, headached, myalgias, low grade fever, intense arthralgias, red skin on trunk. Reaction continued to 6-26-09 with intense joint stiffness,pain, generalized skin erythema and flushing. Continued to 6-27-09 with intense neck stiffness, joint effusion on right knee, right ankle, swollen hands, continued generalized skin erythema. Some improvement on 6-28-09. 90% improved on 6-29-09. Hand swelling and joint effusions had gradually improved.
Age: 51.0
Sex: M
Vaccine: HEPA
Symptoms: Joint stiffness, Musculoskeletal stiffness, Myalgia, Oedema peripheral, Pyrexia
Clinical narrative: Vaccine administered 6-22-09, 2nd dose of Hepatitis A vacccine. That evening headache, myalgias, chills, low grade fever 99.3. Evening of 6-25-09, headached, myalgias, low grade fever, intense arthralgias, red skin on trunk. Reaction continued to 6-26-09 with intense joint stiffness,pain, generalized skin erythema and flushing. Continued to 6-27-09 with intense neck stiffness, joint effusion on right knee, right ankle, swollen hands, continued generalized skin erythema. Some improvement on 6-28-09. 90% improved on 6-29-09. Hand swelling and joint effusions had gradually improved.
Age: 51.0
Sex: M
Vaccine: HEPA
Symptoms: Rash erythematous
Clinical narrative: Vaccine administered 6-22-09, 2nd dose of Hepatitis A vacccine. That evening headache, myalgias, chills, low grade fever 99.3. Evening of 6-25-09, headached, myalgias, low grade fever, intense arthralgias, red skin on trunk. Reaction continued to 6-26-09 with intense joint stiffness,pain, generalized skin erythema and flushing. Continued to 6-27-09 with intense neck stiffness, joint effusion on right knee, right ankle, swollen hands, continued generalized skin erythema. Some improvement on 6-28-09. 90% improved on 6-29-09. Hand swelling and joint effusions had gradually improved.
Age: 19.0
Sex: F
Vaccine: HPV4
Symptoms: Erythema, Lymphadenopathy, Oedema, Urticaria
Clinical narrative: Erythema, edema, hives, lymphadenopathy, treated with prednisone
Age: 1.0
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Rash
Clinical narrative: pt with c/o rash onset 6/28/2009 and was seen in office. pt had varicella vaccine 6/18/2009.
Age: 14.0
Sex: F
Vaccine: HPV4, MNQ
Symptoms: Asthenia, Dysgeusia, Dyskinesia, Feeling cold, Hyperhidrosis
Clinical narrative: fainted immediatley with slight jerking motion.  B/P 80/40, pulse 60.  Woke a couple seconds later very cold, shaky, 80/50.  Very diaphoretic, pale, weak.  Client did not eat this AM.  Had "bad taste in mouth" Client stayed lying down for 30 minutes before she felt strong enought to stand.  Last B/P before leaving was 80/50.  Gave her a glass of apple juice.
Age: 14.0
Sex: F
Vaccine: HPV4, MNQ
Symptoms: Immediate post-injection reaction, Pallor, Syncope, Tremor
Clinical narrative: fainted immediatley with slight jerking motion.  B/P 80/40, pulse 60.  Woke a couple seconds later very cold, shaky, 80/50.  Very diaphoretic, pale, weak.  Client did not eat this AM.  Had "bad taste in mouth" Client stayed lying down for 30 minutes before she felt strong enought to stand.  Last B/P before leaving was 80/50.  Gave her a glass of apple juice.
Age: 27.0
Sex: M
Vaccine: MMR, TDAP, VARCEL
Symptoms: Cyanosis, Muscle rigidity, Muscle tightness, Tension, Tremor
Clinical narrative: Pt received vaccines ~ 1230 pm. Pt. tolerated well. Received Tdap, MMR,  Varicella, and ppd. Asked pt. if I could procede with obtaining blood  at which point he nodded yes. Pt. was in sitting position-Began drawing lab specimen on patient which included 2 tiger tops and 1 lavender container. Lab test to be obtained  Hep A,B,C, HIV, RPR. At ~1240 when last tube was obtained noticed patient body core, lower and upper extremities tensed up, fists clenched and became very rigid. Whole body then shook for ~8 seconds- after this patient face became a bluish color and jaw tightened. This lasted about 6 seconds. Turned on fan in lab and tapped Pt. on face. I placed patient on the floor from sitting position and placed him in recovery position on the floor of the lab. Pt. was unable to follow or respond to verbal commands for ~2-3 minutes. EMS initiated at ~1241 by LVN. BP obtained when patient was in recovery position = 90/50, P= 60, RBS = 101 mg/dl. Pt. spoke to interpreter on phone. Denied previous history of seizure or seizure like activity. Pt. evaluated by FNP. Please see Referral form to ER completed by FNP. Pt. sent to Hospital via EMS for evaluation and treatment. A&O x 3 at discharge.
Age: 27.0
Sex: M
Vaccine: MMR, TDAP, VARCEL
Symptoms: Unresponsive to stimuli
Clinical narrative: Pt received vaccines ~ 1230 pm. Pt. tolerated well. Received Tdap, MMR,  Varicella, and ppd. Asked pt. if I could procede with obtaining blood  at which point he nodded yes. Pt. was in sitting position-Began drawing lab specimen on patient which included 2 tiger tops and 1 lavender container. Lab test to be obtained  Hep A,B,C, HIV, RPR. At ~1240 when last tube was obtained noticed patient body core, lower and upper extremities tensed up, fists clenched and became very rigid. Whole body then shook for ~8 seconds- after this patient face became a bluish color and jaw tightened. This lasted about 6 seconds. Turned on fan in lab and tapped Pt. on face. I placed patient on the floor from sitting position and placed him in recovery position on the floor of the lab. Pt. was unable to follow or respond to verbal commands for ~2-3 minutes. EMS initiated at ~1241 by LVN. BP obtained when patient was in recovery position = 90/50, P= 60, RBS = 101 mg/dl. Pt. spoke to interpreter on phone. Denied previous history of seizure or seizure like activity. Pt. evaluated by FNP. Please see Referral form to ER completed by FNP. Pt. sent to Hospital via EMS for evaluation and treatment. A&O x 3 at discharge.
Age: 49.0
Sex: F
Vaccine: HEPAB
Symptoms: Contusion, Injected limb mobility decreased, Injection site pain, Oedema peripheral, Pain in extremity
Clinical narrative: Patient states that Right arm became swollen and painful, then began to hurt deep inside the muscle from the injection site to the wrist, patient still has pain in her right arm when she lifts the arm above her shoulder.  Patient also states that a bruise developed one month after receiving the shot.  On physical exam today, injection site is WNL.  Not painful to touch.  Recommend patient follow up with primary care physician at next appointment.  Patient has appointment 07/14/2009.
Age: 11.0
Sex: M
Vaccine: MNQ, TDAP
Symptoms: Fall, Head injury, Loss of consciousness, Skin laceration
Clinical narrative: Patient passed out in the hallway about 3 minutes after receiving vaccines. Mother was with him at the time. She reports that he fell face first and hit his head on the carpet. She says he was out cold for about 6 seconds. Myself and the other nurse were called to the hall to assist. Patient was found lying on the floor with his head in his mother's arms. He was conscious and speaking. He had a laceration on his forehead. I called 9-1-1 to report the incident while the other nurse applied pressure to the wound and had the patient drink Sprite. The patient was escorted out on a stretcher by ER staff.
Age: 63.0
Sex: F
Vaccine: VARZOS
Symptoms: Blood test, Oedema peripheral, Urticaria
Clinical narrative: The patient experienced hives 1 week after receiving the Zostavax vaccine on 5/1/2009. She went to urgent care and had her rings cut off because of the swelling on her hands.  The urgent care doctor described the hives as "swelling" and "migratory" where the reaction moves to different places on her body.  Only a physical exam was done.  Ever since then the hives has not cleared yet.  She has been following up with a doctor.  In her most recent visit on 6/29/09, she had some blood tests done with pending results.  She has been using Benadryl on and off to manage the hives.
Age: 0.57
Sex: M
Vaccine: DTAPIPVHIB, PPV, RV5
Symptoms: Appendicectomy, Crying, Ultrasound abdomen, Vomiting
Clinical narrative: Patient received Rotateq 6-12-09, on 06-15-09 mom called and state pt was unconsolable, crying, pushing away from mom and had vomited x 3.  Advised to take to Hospital.  That night he had surgery for intussusception and appendectomy.  7/27/09 Hospital records received DOS 6/15/09 to 6/16/09. Assessment: Ileocolic Intussusception. Patient presents with crampy abdominal pain. Vomiting. Rectum - blood on skin. Enema reduction unsuccessful. Exploratory Lap and appendectomy performed. 9/21/09-ICD-9 codes received-287.0.
Age: 1.0
Sex: M
Vaccine: HEPA, VARCEL
Symptoms: Body temperature increased
Clinical narrative: Temperature elevation 104 degrees F
Age: 18.0
Sex: M
Vaccine: HEPA
Symptoms: No adverse event
Clinical narrative: No adverse reaction noted. Verified with patient and mother.
Age: 11.0
Sex: F
Vaccine: DTAP
Symptoms: Crying, Headache, Pain, Pain in extremity, Pyrexia
Clinical narrative: Shot was administered around 4:15 June 29th.  Pt woke up at 6 a.m. the following day crying in pain, headache rated 10 on scale of 1-10.  She had a fever of 101.6, arm hurt and body aches. Took her to Dr. office at 7:20 in the morning, they ran strep test and checked white count which was normal.  No other definitive reason for being ill.
Age: 11.0
Sex: F
Vaccine: DTAP
Symptoms: Streptococcal identification test negative, White blood cell count normal
Clinical narrative: Shot was administered around 4:15 June 29th.  Pt woke up at 6 a.m. the following day crying in pain, headache rated 10 on scale of 1-10.  She had a fever of 101.6, arm hurt and body aches. Took her to Dr. office at 7:20 in the morning, they ran strep test and checked white count which was normal.  No other definitive reason for being ill.
Age: 16.0
Sex: F
Vaccine: HPV4
Symptoms: Abdominal pain upper, Dizziness, Hypotension
Clinical narrative: Pt c/o "dizziness", stomach pain within seconds of administration.  Pt closed eyes at this time. Pt placed in supine position with knees raised to chest.  BP 90/60.  Pt left in position for 5 minutes. Hypotension noted when raised from supine to sitting position, 75/42 taken manually on left arm.  Pt placed back in supine position with knees raised x 10 min.  BP returned to WNL and pt had no c/o dizziness.
Age: 13.0
Sex: F
Vaccine: HPV4
Symptoms: Drooling, Facial palsy, Hypoaesthesia facial
Clinical narrative: Inability to close right eye, facial numbness, drooling from right side of mouth  Dx: Bells Palsy
Age: 14.0
Sex: F
Vaccine: HPV4, VARCEL
Symptoms: Immediate post-injection reaction, Syncope
Clinical narrative: Patient received Varivax, Gardasil, and PPD. Within in minutes she fainted.
Age: 0.2
Sex: M
Vaccine: DTAPIPVHIB, HEP, PNC, RV5, DTAP, HEP, IPV, PNC, RV5
Symptoms: Intussusception, Surgery
Clinical narrative: Rotateq given on 6-18-09 & patient had to undergo surgery for intussusception on 6-22-09.  9/8/09 Hospital records received DOS 6/21/09 to 6/25/09. Assessment: Intussusception status post exploratory laparatomy for reduction and appendectomy. Patient presented with a history of vomiting yesterday morning X3. Gagging, poor oral intake, some discomfort, decreased activity level. Cries out during abdominal examination. Blood in stool, anal fissure. Reduction of intussusception, bowel necrosis, appendectomy performed.  9/4/09 Received hospital ICD9 codes: 5600; 542; 56089; 5601; 78062; 5609.
Age: 5.0
Sex: F
Vaccine: DTAPIPV, HEPA, MMR, VARCEL
Symptoms: Auricular swelling, Dyspnoea, Eye swelling, Lip swelling, Vomiting
Clinical narrative: Patient had swelling of the eye's, lip's and ear's. Also had an episode of vomiting. some difficulty breathing.Patient was given vaccines and had left the clinic for about 30 min. at which point she started to react. Patient was rushed back to out clinic where she was given Benadryl and supervised for 30mins. at this point she seamed to be acting normal with still some swelling so Dr. sent her home. Mom to call with any other issues within a 24hr period. no swelling at any of the injection sites were noted.
Age: 3.0
Sex: M
Vaccine: HEP, HIBV
Symptoms: Inappropriate schedule of drug administration
Clinical narrative: My son received two vaccinations, Hib and HepB. He did not need either one of those shot.  I found out when I compared the shot record that they gave me today and the shot record from his previous pediatrician in Shreveport, that over 75% of his shot record had been entered incorrectly into their database. As I looked at the shot record they gave me today it had a 09/18/2009 date on their for the 1st HepA date.  Well that caught my eye because it's only June 2009. So I checked the entire shot record and 75% of the shot record provided by Napoleon Pediatrics had incorrect dates and some of the dates were missing.
Age: 4.0
Sex: M
Vaccine: DTAP, FLUX, HEPA, IPV, MMR, VARCEL
Symptoms: Rash, Varicella post vaccine
Clinical narrative: Child was evaluated on 6/30/09 and noted to have confirmed case of diffuse varicella. Child's rash involved dozens of varicella lesions on trunk, back, abdomen, arms and legs, only a few on face. He appeared otherwise well without fever or other symptoms. Mild case.
Age: 11.0
Sex: M
Vaccine: DTAP, HEP
Symptoms: Injection site erythema, Injection site macule, Injection site pruritus, Urticaria
Clinical narrative: Patient developed bright red macule about 3 in. diameter at the site which was itchy and also developed generalized hives.  Both noted about 3 days after imm. given.  He was also on Amoxicillin at the time for a sinusitis and I think the hives were due to an allergic reaction to the Amox.
Age: 66.0
Sex: M
Vaccine: VARZOS
Symptoms: Dizziness, Nausea, Pyrexia
Clinical narrative: About 2 hours after vaccine administration, patient's wife called and reported the patient experiencing dizziness, nausea, and slight fever.  I spoke with the wife again at 7:30pm, she reported he had improved significantly, but still did not feel like getting up.  The patient completely resolved by 9:00pm.
Age: 2.0
Sex: M
Vaccine: HEPA
Symptoms: Anorexia, Chills, Lethargy, Pyrexia, Tremor
Clinical narrative: High fever,lethargic,shakes,chills,no appetite
Age: 15.0
Sex: M
Vaccine: HEPA, MNQ, TDAP, VARCEL
Symptoms: Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood product transfusion, Chest pain, Myocarditis
Clinical narrative: chest pain, myocarditis treated with IVIG.  7/31/09 Hospital records received DOS 6/28/09 to 7/1/09. Assessment: Myocarditis. Patient presents with fever followed by sharp, nonradiating, substernal chest pain. Worse when lying down and improved with sitting up. Pain left elbow. Emesis. Headache frontal, bilateral pulsatile, with photophobia.  10/13/09 ICD-9 Codes Received: 422.90 Acute myocarditis unpsecified, 346.90 Migraine unspecified not noted as intractable.
Age: 15.0
Sex: M
Vaccine: HEPA, MNQ, TDAP, VARCEL
Symptoms: Troponin increased
Clinical narrative: chest pain, myocarditis treated with IVIG.  7/31/09 Hospital records received DOS 6/28/09 to 7/1/09. Assessment: Myocarditis. Patient presents with fever followed by sharp, nonradiating, substernal chest pain. Worse when lying down and improved with sitting up. Pain left elbow. Emesis. Headache frontal, bilateral pulsatile, with photophobia.  10/13/09 ICD-9 Codes Received: 422.90 Acute myocarditis unpsecified, 346.90 Migraine unspecified not noted as intractable.
Age: 20.0
Sex: M
Vaccine: FLUN3, HEPAB, MMR, MNQ, PPV
Symptoms: Abasia, Asthenia, Ataxia, Balance disorder, Bilirubin urine
Clinical narrative: Pt was in excellent health prior to service entry in May 2009. 13 May 2009 - Pt received multiple vaccines - See Vaccine History. The total number of 5 vaccines administered was divided between injections in both of his arms (2 and 3). He does not recall any significant local reactions at his vaccination sites. 28 May 2009 - Pt reported to Sick call for evaluation of URI symptoms. He was treated with MUCINEX, TYLENOL and SUDAFED. He reports multiple sick contacts with similar URI symptoms. 1 June 2009 - Seen on Sick Call. Diagnosed with Bronchitis and prescribed ZITHROMAX. 2 June 2009 - Pt awoke with tingling, numbness and weakness of his entire body, except for his head and neck. He was seen on sick call for follow up of bronchitis and he was placed on 72 hour quarters. (There was no mention of the numbness or weakness in the clinic note.) 5June 2009 - Pt returned to Sick Call with c/o falling "to his knees...can't feel legs, feet, shins, hands and fingers". (URI symptoms noted to have significantly improved.) No bowel or bladder symptoms or visual changes. Pt was released to duty. 8 June 2009 - Pt seen in the clinic for "body numbness". The following were noted: - Gait "off balance", ataxia, difficulty with balance - Increased concentration required to get dressed as buttons and laces hard to manipulate - Unable to feel when he plants his feet down - Difficulty writing and with fine manipulative tasks - Placed on 48 hour quarters. 10 June 2009 - Pt returned to sick call with c/o body numbness x 10 days and was referred to the ER after PCM consulted with Neurology. 11 June 2009 - Neurologist evaluated patient. HPI noted 10 day hx of numbness of all extremities and entire body, with subsequent generalized weakness, gait difficulty, soreness of calves and thighs. Exam revealed slightly diminished strength of UE and LE (4/5), with 3+/5 strength of distal muscle groups. Also on exam, pt was unable to walk a straight line, with abnormal heel walking and diminished DTRs in UEs and absent DTRs in LEs. Diagnosed with GBS. Treated with IVIGx5 days. Transferred to inpatient rehabilitation facility.  7/27/09 Hospital records received DOS 6/11/09 to 6/16/09. Discharge Diagnosis: Guillaine Barre Syndrome Patient c/o significant numbness in fingers and toes with generalized numbness of body below the neck.  Stumbles when he walks. Arthragias of knees, myalgias in thighs and calves. Easily fatigued, anorexia. URI symptoms such as cough and sore throat, 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. Presence of CSF albuminocytologic dissociation (slightly elevated CSF protein with absent pleocytosis).
Age: 20.0
Sex: M
Vaccine: FLUN3, HEPAB, MMR, MNQ, PPV
Symptoms: Blood culture negative, Blood product transfusion, Bronchitis, C-reactive protein increased, CSF culture negative
Clinical narrative: Pt was in excellent health prior to service entry in May 2009. 13 May 2009 - Pt received multiple vaccines - See Vaccine History. The total number of 5 vaccines administered was divided between injections in both of his arms (2 and 3). He does not recall any significant local reactions at his vaccination sites. 28 May 2009 - Pt reported to Sick call for evaluation of URI symptoms. He was treated with MUCINEX, TYLENOL and SUDAFED. He reports multiple sick contacts with similar URI symptoms. 1 June 2009 - Seen on Sick Call. Diagnosed with Bronchitis and prescribed ZITHROMAX. 2 June 2009 - Pt awoke with tingling, numbness and weakness of his entire body, except for his head and neck. He was seen on sick call for follow up of bronchitis and he was placed on 72 hour quarters. (There was no mention of the numbness or weakness in the clinic note.) 5June 2009 - Pt returned to Sick Call with c/o falling "to his knees...can't feel legs, feet, shins, hands and fingers". (URI symptoms noted to have significantly improved.) No bowel or bladder symptoms or visual changes. Pt was released to duty. 8 June 2009 - Pt seen in the clinic for "body numbness". The following were noted: - Gait "off balance", ataxia, difficulty with balance - Increased concentration required to get dressed as buttons and laces hard to manipulate - Unable to feel when he plants his feet down - Difficulty writing and with fine manipulative tasks - Placed on 48 hour quarters. 10 June 2009 - Pt returned to sick call with c/o body numbness x 10 days and was referred to the ER after PCM consulted with Neurology. 11 June 2009 - Neurologist evaluated patient. HPI noted 10 day hx of numbness of all extremities and entire body, with subsequent generalized weakness, gait difficulty, soreness of calves and thighs. Exam revealed slightly diminished strength of UE and LE (4/5), with 3+/5 strength of distal muscle groups. Also on exam, pt was unable to walk a straight line, with abnormal heel walking and diminished DTRs in UEs and absent DTRs in LEs. Diagnosed with GBS. Treated with IVIGx5 days. Transferred to inpatient rehabilitation facility.  7/27/09 Hospital records received DOS 6/11/09 to 6/16/09. Discharge Diagnosis: Guillaine Barre Syndrome Patient c/o significant numbness in fingers and toes with generalized numbness of body below the neck.  Stumbles when he walks. Arthragias of knees, myalgias in thighs and calves. Easily fatigued, anorexia. URI symptoms such as cough and sore throat, 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. Presence of CSF albuminocytologic dissociation (slightly elevated CSF protein with absent pleocytosis).
Age: 20.0
Sex: M
Vaccine: FLUN3, HEPAB, MMR, MNQ, PPV
Symptoms: CSF glucose normal, CSF lymphocyte count normal, CSF monocyte count, CSF protein increased, CSF test abnormal
Clinical narrative: Pt was in excellent health prior to service entry in May 2009. 13 May 2009 - Pt received multiple vaccines - See Vaccine History. The total number of 5 vaccines administered was divided between injections in both of his arms (2 and 3). He does not recall any significant local reactions at his vaccination sites. 28 May 2009 - Pt reported to Sick call for evaluation of URI symptoms. He was treated with MUCINEX, TYLENOL and SUDAFED. He reports multiple sick contacts with similar URI symptoms. 1 June 2009 - Seen on Sick Call. Diagnosed with Bronchitis and prescribed ZITHROMAX. 2 June 2009 - Pt awoke with tingling, numbness and weakness of his entire body, except for his head and neck. He was seen on sick call for follow up of bronchitis and he was placed on 72 hour quarters. (There was no mention of the numbness or weakness in the clinic note.) 5June 2009 - Pt returned to Sick Call with c/o falling "to his knees...can't feel legs, feet, shins, hands and fingers". (URI symptoms noted to have significantly improved.) No bowel or bladder symptoms or visual changes. Pt was released to duty. 8 June 2009 - Pt seen in the clinic for "body numbness". The following were noted: - Gait "off balance", ataxia, difficulty with balance - Increased concentration required to get dressed as buttons and laces hard to manipulate - Unable to feel when he plants his feet down - Difficulty writing and with fine manipulative tasks - Placed on 48 hour quarters. 10 June 2009 - Pt returned to sick call with c/o body numbness x 10 days and was referred to the ER after PCM consulted with Neurology. 11 June 2009 - Neurologist evaluated patient. HPI noted 10 day hx of numbness of all extremities and entire body, with subsequent generalized weakness, gait difficulty, soreness of calves and thighs. Exam revealed slightly diminished strength of UE and LE (4/5), with 3+/5 strength of distal muscle groups. Also on exam, pt was unable to walk a straight line, with abnormal heel walking and diminished DTRs in UEs and absent DTRs in LEs. Diagnosed with GBS. Treated with IVIGx5 days. Transferred to inpatient rehabilitation facility.  7/27/09 Hospital records received DOS 6/11/09 to 6/16/09. Discharge Diagnosis: Guillaine Barre Syndrome Patient c/o significant numbness in fingers and toes with generalized numbness of body below the neck.  Stumbles when he walks. Arthragias of knees, myalgias in thighs and calves. Easily fatigued, anorexia. URI symptoms such as cough and sore throat, 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. Presence of CSF albuminocytologic dissociation (slightly elevated CSF protein with absent pleocytosis).
Age: 20.0
Sex: M
Vaccine: FLUN3, HEPAB, MMR, MNQ, PPV
Symptoms: CSF white blood cell count negative, Chest X-ray normal, Computerised tomogram abnormal, Culture stool negative, Disturbance in attention
Clinical narrative: Pt was in excellent health prior to service entry in May 2009. 13 May 2009 - Pt received multiple vaccines - See Vaccine History. The total number of 5 vaccines administered was divided between injections in both of his arms (2 and 3). He does not recall any significant local reactions at his vaccination sites. 28 May 2009 - Pt reported to Sick call for evaluation of URI symptoms. He was treated with MUCINEX, TYLENOL and SUDAFED. He reports multiple sick contacts with similar URI symptoms. 1 June 2009 - Seen on Sick Call. Diagnosed with Bronchitis and prescribed ZITHROMAX. 2 June 2009 - Pt awoke with tingling, numbness and weakness of his entire body, except for his head and neck. He was seen on sick call for follow up of bronchitis and he was placed on 72 hour quarters. (There was no mention of the numbness or weakness in the clinic note.) 5June 2009 - Pt returned to Sick Call with c/o falling "to his knees...can't feel legs, feet, shins, hands and fingers". (URI symptoms noted to have significantly improved.) No bowel or bladder symptoms or visual changes. Pt was released to duty. 8 June 2009 - Pt seen in the clinic for "body numbness". The following were noted: - Gait "off balance", ataxia, difficulty with balance - Increased concentration required to get dressed as buttons and laces hard to manipulate - Unable to feel when he plants his feet down - Difficulty writing and with fine manipulative tasks - Placed on 48 hour quarters. 10 June 2009 - Pt returned to sick call with c/o body numbness x 10 days and was referred to the ER after PCM consulted with Neurology. 11 June 2009 - Neurologist evaluated patient. HPI noted 10 day hx of numbness of all extremities and entire body, with subsequent generalized weakness, gait difficulty, soreness of calves and thighs. Exam revealed slightly diminished strength of UE and LE (4/5), with 3+/5 strength of distal muscle groups. Also on exam, pt was unable to walk a straight line, with abnormal heel walking and diminished DTRs in UEs and absent DTRs in LEs. Diagnosed with GBS. Treated with IVIGx5 days. Transferred to inpatient rehabilitation facility.  7/27/09 Hospital records received DOS 6/11/09 to 6/16/09. Discharge Diagnosis: Guillaine Barre Syndrome Patient c/o significant numbness in fingers and toes with generalized numbness of body below the neck.  Stumbles when he walks. Arthragias of knees, myalgias in thighs and calves. Easily fatigued, anorexia. URI symptoms such as cough and sore throat, 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. Presence of CSF albuminocytologic dissociation (slightly elevated CSF protein with absent pleocytosis).
Age: 20.0
Sex: M
Vaccine: FLUN3, HEPAB, MMR, MNQ, PPV
Symptoms: Dysgraphia, Electromyogram abnormal, Epstein-Barr virus antibody negative, Epstein-Barr virus antibody positive, Fall
Clinical narrative: Pt was in excellent health prior to service entry in May 2009. 13 May 2009 - Pt received multiple vaccines - See Vaccine History. The total number of 5 vaccines administered was divided between injections in both of his arms (2 and 3). He does not recall any significant local reactions at his vaccination sites. 28 May 2009 - Pt reported to Sick call for evaluation of URI symptoms. He was treated with MUCINEX, TYLENOL and SUDAFED. He reports multiple sick contacts with similar URI symptoms. 1 June 2009 - Seen on Sick Call. Diagnosed with Bronchitis and prescribed ZITHROMAX. 2 June 2009 - Pt awoke with tingling, numbness and weakness of his entire body, except for his head and neck. He was seen on sick call for follow up of bronchitis and he was placed on 72 hour quarters. (There was no mention of the numbness or weakness in the clinic note.) 5June 2009 - Pt returned to Sick Call with c/o falling "to his knees...can't feel legs, feet, shins, hands and fingers". (URI symptoms noted to have significantly improved.) No bowel or bladder symptoms or visual changes. Pt was released to duty. 8 June 2009 - Pt seen in the clinic for "body numbness". The following were noted: - Gait "off balance", ataxia, difficulty with balance - Increased concentration required to get dressed as buttons and laces hard to manipulate - Unable to feel when he plants his feet down - Difficulty writing and with fine manipulative tasks - Placed on 48 hour quarters. 10 June 2009 - Pt returned to sick call with c/o body numbness x 10 days and was referred to the ER after PCM consulted with Neurology. 11 June 2009 - Neurologist evaluated patient. HPI noted 10 day hx of numbness of all extremities and entire body, with subsequent generalized weakness, gait difficulty, soreness of calves and thighs. Exam revealed slightly diminished strength of UE and LE (4/5), with 3+/5 strength of distal muscle groups. Also on exam, pt was unable to walk a straight line, with abnormal heel walking and diminished DTRs in UEs and absent DTRs in LEs. Diagnosed with GBS. Treated with IVIGx5 days. Transferred to inpatient rehabilitation facility.  7/27/09 Hospital records received DOS 6/11/09 to 6/16/09. Discharge Diagnosis: Guillaine Barre Syndrome Patient c/o significant numbness in fingers and toes with generalized numbness of body below the neck.  Stumbles when he walks. Arthragias of knees, myalgias in thighs and calves. Easily fatigued, anorexia. URI symptoms such as cough and sore throat, 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. Presence of CSF albuminocytologic dissociation (slightly elevated CSF protein with absent pleocytosis).