Age: 24.0
Sex: M
Vaccine: ANTH, MMR, YF, ANTH, MMR, YF, SMALL
Symptoms: Infection transmission via personal contact, Skin ulcer
Clinical narrative: From initial information received on 12/08/2003 through an enhanced surveillance program conducted by the CDC (VAERS # 212904), it was reported that a 24 year old male pt received a dose of Yellow Fever vaccine (lot number, manufacturer, route and site of administration not reported) on 05/13/03.  The pt was also vaccinated with his third dose of Anthrax vaccine (lot number, manufacturer, route and site of administration not reported) on 04/20/03.  The pt developed severe testicle pain and migraines on 05/28/03.  In 10/2003 the pt had a seizure, which the MD's believed to be due to epididymitis, a severe infection of the testicle.  The pt was hospitalized for three days. Due to the approximately five month time frame between vaccination and the seizure/hospitalization, it was not requested to test the CSF sample at CDC.  The seizure has not reoccurred.  The pt's recovery status was not reported.  Medical records were requested by CDC.  From additional info received on 12/15/03 from the CDC (VAERS #212904), it was reported that on 5/28/03, the pt also developed testicular swelling. The date of administration of the Yellow Fever vaccine was reported as 4/20/03, the date on which the pt also received his third dose of anthrax vaccine and onset of all adverse events was 5/28/03. It was reported that the pt was treated with several courses of antibiotics, but the testicular pain and swelling persist. Pt was also treated with Dilantin for two days for his seizure. There was no recurrence to date. The pt did not receive any further anthrax vaccines. In addition to this info, it was stated that the pt received his first dose of the anthrax vaccine, administered in his left arm as well as an MMR vaccine and a PPB TB, for which no other info was provided, on 3/23/03 at 9:00 am. THe pt received his second dose of the anthrax vaccine on 4/6/03. It was also stated that the pt developed sleeping disorder. His relevant diagnostic testing at that time included a CAT scan, EEG, ultrasound and a spinal tap. The pt has not recovered at tha time. His current recovery status was not reported. No other info was provided at this time.  Follow up information received from an agency noted the patinet smokes (how many packs per day was unknown) and has allergies to doxycycline, PCN and had a history of right inguinal herniorrhaphy (traumatic hernia) in May 2002 and a gunshot wound to the right chest (no sequelae) in July 2002. Information received also noted that the patient had no significant past medical history and was in an unusual state of health until approximately two months following a yellow fever virus vaccine vaccination when he developed testicular swelling and pain. He was diagnosed with epidiymitis by a medical doctor and treated with several courses of antibiotics (brands not specified) without resolution. On 15OCT2003 the patient developed severe incapacitating headaches. On the afternoon of 18OCT2003, while sitting on the floor and playing a video game, the patient experienced a grand mal seizure for five minutes. The seizure was witnessed by his wife. The patient had no previous history of seizures.The patient was transported to the hospital on 18oct2003, the patient had a temperature of 99.1 degrees Fahrenheit, but otherwise normal vital signs. The patient was dosed with phenytoin (Dilantin) 300 mg po and admitted. Laboratory evaluation on admission revealed:Utox negative: urinalysis negative, CSF: clear , colorless, RBC 1000, WBC -, Protein 36, glucose 60, gram stain negative, no growth of bacteria/fungi times four days; WBC 14.7 (N65. 4/L27.5); H/H 14.8/43.6; platelets 326; Cr 1.2; electrolytes wnl; total bili 0.6; ALT 35 and AST 23. He was placed on bed rest and started on phenytoin (Dilantin) 100 mg po tid as well as acetaminophen+ butalbital + caffein (Fioricet) 1 tab every 6 prn for headache. At rounds in the am of 19OCT2003 the patient was given acetaminophen + hydrocodone bitartrate (Lortab) 7.5 one tab every four hours for pain, ceftriaxone sodium (Rocephin) 1 g q12h IV and azithromycin (Zithromax) dosepak were started.  Patient was seizure free until the am of 20 OCT 2003 when questionable seizure activity was witnessed for less than 45 seconds (without fecal/urinary incontinence). No dizzines, confusion or neurological deficits were noted. All vital signs were stable. Hospital studies included CT scan without contrast which was normal and an EEG which was symptom free he was discharged on azithromycin (Zithromax) dosepak and prn pain meds. His discharge diagnosis was grand mal seizure., isolated and headaches. Reportedly the first onset to symptoms began approximately two months followng the yellow fever vaccinatioin and the second symptoms began seven months after vacciunation (previously reported as epididymitis, testicle pain, migrains, testicular swelling and a sleep disorder on 28MAY2003 and seizure in October 2003).  Follow up information from the agency reported that this case was classified as "not related to yellow fever vaccine" by "yellow fever working group". No further information was provided at thistime. Other business partner numbers include: 2003-03321 and 212904.