Age: 20.0
Sex: F
Vaccine: HEPA, IPV, MNQ, RAB, TYP, YF, HEPA, IPV, MNQ, RAB, TYP, YF
Symptoms: Tremor
Clinical narrative: Initial report received from a health care professional on 04 May 2011. A 20-year-old female patient received on 01 March 2011 the following vaccines (manufacturers and lot numbers not reported): YF VAX (first dose), IPV (adult dose), oral typhoid vaccine, hepatitis A vaccine (first dose), MENVEO vaccine, and RABAVERT (first dose). On 09 March 2011, the patient received a second dose of RABAVERT. On 10 March 2011, the patient developed "tremors, diffuse headache and feeling dazed". On 11 March 2011, the patient had a physical exam of a neuro exam, gait, strength, vital signs all within normal limits, yet she did demonstrated mild tremors to her hands, arms and feet. Her symptoms began after the second dose of the rabies vaccine. It was determined by the CDC that it may or may not have been the RABAVERT vaccine that was the cause and encouraged the patient to complete the series but instead switch to IMOVAX for the last dose. When the patient returned for her follow-up appointment on 14 March 2011, her symptoms were resolved. The patient, on schedule, was switched to IMOVAX (lot number not reported) for the last dose which was given on 06 April 2011. The outcome was reported as resolved. Follow-up information was received from a health care professional on 07 June 2011 reported that the patient had a history of allergy to bee stings, anxiety, depression, suicide attempt, migraine headaches, sleeping difficulty, and poly cystic ovarian syndrome (PCOS). The patient did not relay any physical illness at the time of vaccination and at the time of vaccination was pleasant and appeared well. Her concomitant medications included GLUCOPHAGE, SEROQUEL, NECON, WELLBUTRIN, CELEXA, and VISTARIL prn. Clarification was received for the patient vaccines that were received on 01 March 2011 as follows: a subcutaneous left arm injection (dose 1) of YF VAX, sanofi pasteur lot number UF802AA, a subcutaneous right arm injection of IPOL, sanofi pasteur lot number D1086 (had previously received childhood series), oral TYPHOID VACCINE, Berna lot number 3001879, an intramuscular left deltoid injection of HAVRIX (first dose), GSK lot number AHAVB443BA, an intramuscular injection (dose 1) of MENVEO vaccine, Novartis lot number A-X11027, and an intramuscular right deltoid injection RABAVERT (first dose), Novartis lot number 464011C. On 09 March 2011, the patient received a second dose intramuscular injection of RABAVERT, Novartis lot number 464011C. On 10 March 2011, the patient had called the physicians office and was advised to come to health center. On 11 March 2011, the patient required an office visit where she was evaluated by a physician assistant who consulted a medical doctor via phone. She complained of tremor/shakiness since yesterday, feeling dazed (not right), and headache that was different than any other "depression" headache (diffuse) and was behind eyes. She had tried eating thinking she had low blood sugar but had none. She has no past medical history of diabetes mellitus. This had resolved. She did not sleep well and awoke many times but states that she sometimes has issues with sleeping well. She had positive concentration, alert, oriented to time, place and person (x3), able to recall significant facts, Pupils Equal, Round, Reactive to Light and Accommodation (PERRLA), CN II - CN XII grossly intact, strength and sensory in limbs 5 out of 5 (all limbs), good capillary refill, no neck pain with flex or extension, and range of motion (ROM) within normal limits. She had positive tremor in arms, lower mandible and legs. It was recommended by the doctor that she not receive dose 3 (vaccine not stated). The patient was treated with propanolol 10 milligrams (mg) every 6 hours (#10). The plan was to have patient return for a re-check on 14 March 2011 and if tremors were still present then the patient would have a neurology consult. On 14 March 2011, the patient was re-evaluated by the physician assistant. She still had hand tremor but felt tremor improved from the last visit. She did not need the propanolol. The plan was to switch to human embryo rabies vaccine for dose 3. The tremors were almost non-existent and were very mild symptoms compared to 11 March 2011. The patient's headache continued but this was a chronic condition that occurred prior to immunizations. Her neuro exam showed the following: PERRLA, CN II - CN XIII intact, gait normal, no signs of facial drooping and pharynx within normal limits. The patient had no laboratory or diagnostic testing performed. She was not seen by an allergist. The tremors were resolved. The patient was to receive IMOVAX (Human Genome) vaccine for rabies prophylactic #3. The patient has since received an intramuscular injection of IMOVAX, sanofi pasteur SA lot number E0393, on 06 April 2011. The outcome was reported as resolved. Documents held by sender: None.