See copy of medical records for initial report.  Patient was admitted in hospital from 4/8 to 5/1/2008 with diagnosis of Peripheral nerve DOS and dysphagia. 7/21/08-records received for dates of service 4/16-5/1/08-DC DX:Guillain Barre syndrome, Acute inflammatory demyelinating polyneuropathy (AIDP). Right lower lobe pneumonia. Presented on 4/8/08 with parasthesias of upper and lower extremities, weakness of right upper extremity, generalised areflexia, tingling of hands and feet, evidence of bulbar involvement, weak cough, absent gag reflex, nasal twang, slurred speech. On admission C/O left upper extremity weakness. Treated with IVIG. Admitted to rehab with unsteady gait and residual slurred speech with mild dysphagia and near complete resolution of weakness in lower and left upper extremities. PE: DTR diminished.  This case was initially reported to the Centers for Disease Control and Prevention (CDC) by a health professional. The case was subsequently forwarded by the CDC, and was received on 15 September 2008. A 20-year-old male service member received the following vaccines on 21 March 2008: a left arm intramuscular injection of ADACEL (lot number C2869AA), an intramuscular left arm injection of MENACTRA (lot number U2567AA), a right arm injection of influenza vaccine (GlaxoSmithKline, lot number AFLLA050A), an intramuscular left arm injection of Hepatitis A and B vaccine (GlaxoSmithKline, lot number AHABB108AA), and a subcutaneous left arm injection of MMR II (Merck, lot number 0871U). On 05 April 2008, 15 days after vaccination, the patient began experiencing upper respiratory symptoms, including cough and runny nose. He was treated with Bicillin. On 08 April 2008 be presented to the hospital with paresthesias of the upper and lower extremities, weakness of the right upper extremity, generalized areflexia, tingling of the hands and feet, a weak cough, absent gag reflex, nasal twang, and slurred speech. In addition, there was also evidence of bulbar involvement, and physical exam demyelinating neuropathy. He was diagnosed with GUILLAIN BARRE Syndrome/acute inflammatory demyelinating polyneuropathy, and right lower lobe pneumonia. Treatment included IVIG (intravenous immunoglobulin therapy). According to medical records received by the CDC, the patient underwent a CT of the brain after undergoing a right temporal craniectomy. It revealed a large arachnoid cyst of right temporal region in right middle cranial fossa, compression deformity and atrophy of right temporal lobe, and shunting tube in arachnoid cyst. Additionally, the CT scan showed acute sinusitis. At the time of his transfer to a rehabilitation facility he had experienced near-complete resolution of weakness the lower and left upper extremities. He continued to have an unsteady gait and residual slurred speech mild dysphagia. 01/Dec/2008: Corrective version was created for the purpose of amending the ADACEL lot number in the product screen to C2869 (previously entered as C2864A). Follow-up information received on 25 March 2009 from the Centers FOR Disease Control and Prevention (CDC) (VAERS number 316502). The level to diagnostic certainty for this confirmed GBS case is level 2. Documents held by sender: None.