Age: 19.0
Sex: M
Vaccine: ANTH, HEPAB, JEV1, SMALL
Symptoms: Activated partial thromboplastin time normal, Anion gap, Back pain, Basophil count decreased, Basophil percentage decreased
Clinical narrative: This unsolicited case was received on 11-JAN-2017 via a third party query tool search on the VAERS database, under reference number 648056. This case involves a 19-year-old male patient who was vaccinated with a dose of ACAM2000 (batch number: VV03019C) via percutaneous route in left arm; with a dose of TWINRIX (batch number: 7Z423, manufacture: GLAXOSMITHKLINE) intramuscularly; with a dose BIOTHRAX intramuscularly (manufacturer: EMERGENT); with a dose of IXIARO (manufacturer: INTERCELL, batch number: JEV15D92E) expiry date, dose and route of administration were not reported) on 04 Aug 2016. The patient medical history was included PMH-negative, no known drug allergy. Family history was not reported. Current illness was reported as none. The patient did not have allergic reaction to any previous vaccines. The patient did not receive any concomitant medications. On 11 Aug 16, 07 days following the vaccination, patient had feeling ill, woke up with a rash over his new tattoo site (on 12 Aug 2016), fevers, chills, nausea, photophobia, and lower back pain, 3/10 Intermittent throbbing pain across his forehead mostly associated with fevers, his lower back pain as a dull pain in the middle of his lower back, neck pain that associated with his fevers and pain with neck flexion, existing lesions erupting, draining and by discharge, crusting. On an unknown date, the patient had ACTIVATED PARTIAL THROMBOPLASTIN TIME NORMAL, ANION GAP NORMAL, BAND NEUTROPHIL COUNT INCREASED, BAND NEUTROPHIL PERCENTAGE INCREASED, BASOPHIL COUNT DECREASED, BASOPHIL PERCENTAGE DECREASED, BLOOD CALCIUM NORMAL, BLOOD CHLORIDE DECREASED, BLOOD CREATININE NORMAL, BLOOD CULTURE, BLOOD GLUCOSE NORMAL, BLOOD LACTIC ACID NORMAL, BLOOD MAGNESIUM NORMAL, BLOOD PHOSPHORUS DECREASED, BLOOD POTASSIUM NORMAL, BLOOD SODIUM NORMAL, BLOOD UREA NORMAL, CARBON DIOXIDE NORMAL, EOSINOPHIL COUNT DECREASED, EOSINOPHIL PERCENTAGE DECREASED, GLOMERULAR FILTRATION RATE, HAEMATOCRIT NORMAL, HAEMOGLOBIN NORMAL, INJECTION SITE RASH, INTERNATIONAL NORMALISED RATIO NORMAL, LYMPHOCYTE COUNT DECREASED, LYMPHOCYTE PERCENTAGE DECREASED, MALAISE, MEAN CELL HAEMOGLOBIN CONCENTRATION NORMAL, MEAN CELL HAEMOGLOBIN NORMAL, MEAN CELL VOLUME NORMAL, MEAN PLATELET VOLUME INCREASED, MONOCYTE COUNT DECREASED, MONOCYTE PERCENTAGE, NEUTROPHIL COUNT INCREASED, NEUTROPHIL PERCENTAGE INCREASED, PLATELET COUNT NORMAL, POLYMERASE CHAIN REACTION, PROTHROMBIN TIME PROLONGED, RED BLOOD CELL COUNT NORMAL, RED CELL DISTRIBUTION WIDTH NORMAL, SCAB, STAPHYLOCOCCUS TEST, WHITE BLOOD CELL COUNT INCREASED. He did not notice the rash on any other areas on his body. He denies any sick contacts or recent travel and. On 12 Aug 2016, the patient Admitted to medical center because vaccinia spread into recent tattoo and during hospitalization, existing lesions erupting, draining and by discharge, crusting. Lab investigations included PT, 13.9 SEC; INR 1.1 APTT, 32.4 SEC; WBC 10.4 1000/ mcL; RED BLOOD CELL COUNT, 5.54 MII/uL; Hemoglobin, 16.7 g/dL; HCT, 47.5%; MCV, 85.7 fL; MCH, 30.1 pg; MCHC, 35.2 g/dL; RDW, 12.5%; PLATELETS, 172 1000/uL; MPV, 10.6H fL; NEUTROPHILS %, 84.8H%; LYMPHOCYTES %, 8.0L%; MONOCYTES %, 6.7%; EOSINOPHILS %, 0.1%; BASOPHILS %, 0.2%; IMMATURE GRANS, 0.20%; NEUTROPHILS, 8.83H 1000/uL; LYMPHOCYTES, 0.8L 1000u/L; MONOCYTES 0.70 1000u/L; EOSINOPHILS, 0.0 1000/uL; Basophils, 0.02 1000/uL; ABS IMM GRANS, 0.02 1000/uL; NRBC/100WBC, 0.0/100WBC; GLUCOSE, 110 mg/dl; NA+, 138 mmol/L; K, 3.9 mmol/L; Chloride, 95 L mmol/L; CO2, 25 mmol/L; ANION GAP, 18 mmol/L; CREAT, 1.2 mg/dl; BUN, 12 mg/dl; CA, 10.1 mg/dl; PHOSPHATE, 2.1 L mg/dL; MG, 1.7 mg/dL; GFR-AA, 101 mL/min/m2; GFR-NAA, 87 mL/min/m2; LACTATE, 1.8 mmol/L; Blood cultures (12AUG2016) 4/4. The patient was treated with IV fluids and TYLENOL and Ibuprofen. The patient was not recovered from all events. List of documents held by sender: none. Sender's Comments: Male patient vaccinated with ACAM2000 and other non-company vaccine following which patient presented with multiple symptoms like chills, photophobia, headache, other symptoms with elevated various lab data. Time to onset is compatible, as patient was had tattoo few days ago detail regarding it the dye used, patient medical history, allergic history are needed to further assess the case. Based on available information the role of vaccines cannot be assessed.