10/15 immunizations given, 1026 onset of symptoms, 11/4 admission to hospital, 11/9 discharged from hospital.  Dx probable Guillain Barre syndrome.  See attached for details.  Mr. Wallin is a 45-year-old gentleman who was just diagnosed with Guillain-Barre syndrome.  The patient's train of events includes getting the influenza vaccine and tetanus, TDAP on October 15, 2007.  Later that week, maybe about the 18th or 19th, that is Thursday, Friday or the weekend, had a diarrheal illness for two to three days, not bloody.  All members of the family also got the same diarrheal illness, including his wife, two kids who were ages 6 and 8.  The patient is not aware if his kids developed this diarrheal illness first.  The following week, the week of October 22nd, developed a fever, flu-like illness, with headaches for several days.  That same week developed a feeling of numbness in the tips of his hands and fingers, and started developing progressive weakness.  Had an episode of a rash in his shoulder with a bullet-like rash, approximately 2-3 cm in diameter, which resolved within 1 day.  The patient is not clear if he has had any recent tick bites.  Currently headaches have resolved, fevers have resolved.  The patient has progressive weakness of his lower extremities.  He is now unable to really ambulate without assistance.  He feels that his right side is slightly weaker than the left.  The patient did receive some Doxycycline and Prednisone beginning on November 2, Prednisone 20 mg a day, Doxycycline which he continued through Sunday after which he was admitted on November 4.  Childhood asthma, inguinal hernia repair, wrist fracture.  Tobacco use, but quit on admission.  Alcohol use - daily.  Married, two daughters.  There is some handyman type work.  Multiple sclerosis.  One family member who died of a cerebral aneurysm.  Mother has factor 5 Leiden.  No cough, shortness of breath.  No bowel movement since Sunday.  Vital signs - temperature 36.3, pulse 90, blood pressure 142/92.  Oxygen saturation of 98% on room air.  General - no distress.  HEENT exam - sclerae anicteric.  Mucous membranes are moist.  No thrush.  Cardiovascular exam - regular rate and rhythm, no murmurs or gallops.  Lungs are clear to auscultation, soft, nontender, nondistended.  Positive bowel sounds.  Extremities - no clubbing, cyanosis, or edema.  Neurologic examination - weak hip flexors, knee flexion, extension, dorsiflexion plantar flexion as well as toe flexion, extension, all probably less than 3/5.  Right arm with extension was probably 3/5, right 5/5 flexion and extension, gross sensation seems to be intact in the upper and lower extremities both with standing, with difficulty.  Reflexes are not found in Achilles, patella, brachioradialis or bicipital.  Skin examination - no rashes.  12/04/2007 VAERS report submitted with MR attached for DOS 11/4-9/2007 with Principal DX:  Polyneuropathy and probable Guillain-Barre Syndrome.  2' DX:  Tobacco abuse.  Hyperlipidemia.  ER record of 11/01/07 also received.  Pt seen for paresthsias and unsteadiness on his feet.  MD thought related to anxiety and D/C'd. Pt presented to ER on 11/4/07 with a 2 week hx of distal tingling and numbness beginning in the figertips which spread upward into the hand.  Pt began having weakness and difficulty walking with falls. Pt noted 1 day rash on shoulder.   Neuro consult 11/5/07. Some respiratory distress noted. Pt unable to ambulate w/o assistance at that time.  PE (+) for weakness in multiple muscle groups and absent reflexes (Achilles, patellar, brachioradialis, and bicipital).  Weakness R>L. DX: GBS. Txd with IVIG with dramatic improvement. D/C home with EMG and NCS to be done as an outpt PRN. F/U appt 11/16/07 with pt able to ambulate with only mild gait disturbance.