Patient received the seasonal flu vaccination from her school on January 5, 2021 at the facility. Approximately 2.5 weeks later consistent headache was noted by patient as she resumed her day to day activities and career as a preschool teacher. On January 25, patient reported a tingling sensation in her face followed by repetitive nose flaring and scrunching. Symptoms proceeded to raising of the upper lip bilaterally, right greater than left. Symptoms then progressed to seizure/tic like symptoms, convulsing and shaking of her entire body bilaterally without loss of consciousness. She was then sent to ER on 1/25/21  where evaluation work up was completed.  After initial episode of attacks, patient began to have episodes of nasal flaring, scrunching and locking of the mouth almost every day for one month. January 2021-February 2021. The nasal flaring and jaw symptoms lessened to weekly and then resolved in April/May 2021.   In July of 2021 these episodes/attacks began again consistently with stereotyped involuntary motor movements of whole body, spasticity in limbs, and tingling in nose/face lasting for a minimum of 20 minutes up to an hour. These attacks have caused extreme levels of anxiety, depression, stress and pain unable to complete her day to day tasks and career as she was able to prior. While patient is awake and alert throughout attacks, at times, she is unable to speak due to spasms in mouth causing locking of jaw. When symptoms heightened again in July, an ambulance was called and she was taken to the ER where she was given ativan and discharged home.  In September of 2021, patient was seen by neurologist, who diagnosed her with functional movement disorder. As stated in his detailed assessment,  patient's symptoms may be exacerbated by anxiety and stress triggers yet the actual cause of these attacks and episodes still remains completely unknown. As time progresses, these attacks cause brain and structural changes impacting wellness and optimal functioning.    Fast forward to present day, again it's OCTOBER- almost a year since the initial onset of symptoms requiring hospitalization. Patient has still been experiencing all of these symptoms as explained in depth above including but not limited to:  involuntary stereotyped joint/muscular tics and contractions, spasticity in hands, and stroke like symptoms with facial drooping and tingling of nose.    Prior to receiving the flu shot in January patient was a healthy, happy, functioning 27 year old independent female working, married,  and pursuing a degree in social work while teaching at a pre-school full time. These attacks are not patient's baseline and are are extremely debilitating to her physical, mental AND emotional well being. With the frequency and onset of these attacks almost daily every aspect of her life is impacted. At times she is unable to fulfill her role as a student and as an employee to the severity and intensity of these attacks. Patient was prescribed a muscle relaxant to alleviate pain levels for joint pain with the attacks yet these have an intensive sedating effect and are unrealistic for an individual to take regularly in order to function in society with a career and schooling.   Per neurology report, and testing completed thus far, the definitive cause of these attacks all are consistent with the administration of the influenza vaccination in January of 2021. With patient having no significant past medical history prior to the vaccination there is a high probability the vaccination triggered these attacks.   Patient referred to this writer (me) following initial OT evaluation at facility in September of 2021 for cognitive behavioral therapy treatment. Patient will continue for next 2 months to manage anxiety symptoms and stress levels from these episodes as they are severely impacting all aspects of her every day life and career currently as listed in depth above.  High accredited research studied have shown high correlation rates with flu vaccination and adverse side effects all consistent with patient's symptoms.