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Life Threatening? Yes
Write-up: Information has been received from a physician concerning a 14 year old female patient who on 13-MAR-2008 was vaccinated with her first dose of GARDASIL. Concomitant therapy included MENACTRA. On 09-APR-2008, the patient experienced back pain, fever and headache. The patient was given Z-PAK. On 14-APR-2008, the patient presented at the office with complete facial paralysis and was admitted to the hospital. On 18-APR-2008, the patient was discharged. A neurologist in the hospital diagnosed her with possible Guillain-Barre and bilateral 7th cranial nerve palsy. On 24-APR-2008, the patient was seen by a physician and her adverse events were resolving but not complete. On 15-MAY-2008, the neurologist felt her symptoms were resolving and possibly not related to Guillain-Barre or GARDASIL. The neurologist diagnosed her as having Epstein-Barr meningitis. Back pain, fever, headache, facial paralysis and Epstein-Barr meningitis were considered to be disabling, immediately life-threatening and an other important medical event. Additional information has been requested. 10/3/08 Reviewed neuro medical records of 5/15/2008. FINAL DX: Epstein Barr viral meningitis with montherapy multiplex Records reveal patient experienced HA x 2 weeks in 4/2008. Developed shoulder pain, LBP, sleep disturbance & fever. Seen in ER, dx w/throat lesion & tx w/antibiotics. No response to antibiotic therapy although throat lesion did improve. Developed severe pain, facial weakness, tingling in fingertips. Hospitalized & brain MRI revealed inflammation of VII crainal nerve bilaterally. LP showed WBC (H), protein (H) & marginal glucose indicating viral meningitis. EBV IgM (H). Neuro exam on 5/15/08 revealed right facial weakness w/depressed UE reflexes. 10/31/08 Reviewed hospital medical records of 4/14-4/18/2008. FINAL DX: bilateral 7th cranial nerve palsy, possible variant of GBS triggered by acute Epstein-Barr infection. Records reveal patient experienced HA, muscle aches, fevers, strep throat, mono x approx 2 wks. Developed facial paralysis 3 days prior to admit. Exam revealed cervical & submandibular lymphadenopathy w/peritonsillar erythema. Unable to close eyes completely, could not wrinkle forehead, smile or frown. Right patella areflexia. Neuro consult done. Tx w/IVIG.
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