Age: 65.0
Sex: M
Vaccine: FLU3
Symptoms: Immediate post-injection reaction, Intervertebral disc protrusion, Musculoskeletal stiffness, Nuclear magnetic resonance imaging abnormal, Oedema peripheral
Clinical narrative: Initial case report received from a registered nurse, on 10 NOV 2009. A 65-year-old male patient was vaccinated with FLUVIRIN (batch no. 97838P1) on 22 SEP 2009. The patient developed headaches and dizziness immediately after vaccination. After progression neurologic symptoms (unspecified) he was hospitalized on 05-OCT-2009. The patient was diagnosed with GUILLAIN-BARRE syndrome on 07-OCT-2009. The patient had not recovered, experienced facial numbness, at time of this report. This case was previously reported as MA2009-3984. Follow up report received from a nurse on 15 Mar 2010: The patient had medical history of urinary tract disorder, dysuria, moderate dysuria, mild coronary artery disease (CAD), diabetes (HgbA1c level of 7.3 mg/dl), diabetic peripheral neuropathy, hypertension and chronic obstructive pulmonary disease. The patient was on multiple other medications. The patient presented with back pain and high blood pressure on 22 Sep 2009. On the same day, the patient visited to hospital for evaluation of numbness and paresthesia in the left hand, wrist and forearm. MRI scan of lumbar spine showed herniated disc at L5-S1 on right side. Physical examination showed 2 edema in extremities and brown lesions on the back. The patient was given treatment with oral ciprofloxacin tablet. Smoking, obesity and sedentary life style were considered as risk factors for the patient. On 05 Oct 2009, the patient complained of aches all over with aching from head to toes. There were no fevers, chills, nausea, vomiting, rashes or changes in his condition. The patient received nitroglycerine at home but it caused headaches. HEENT exam results were normal. The patient had atypical diffuse body pain at that time. On 07 Oct 2009, the patient complained of severe pain in his extremities that occurred after taking flu shot a couple of weeks ago. The pain was persisting in the left arm, the patient had myalgic reaction. The patient was prescribed treatment with prednisone 10 mg (3 QD for 5 days and then 2 QD for 5 days and then 1 QD for 5 days and then discontinue). The patient continued to hurt all over body. Therefore, treatment with NEURONTIN was given to the patient. The patient did not respond to the therapies and pain, numbness, weakness and falls continued. Due to all these event, the patient was admitted to the hospital. On 24 Nov 2009, the patient was doing well and regained some strength in arms and legs. Pain was well controlled. HEENT exam showed generalized weakness in all 4 extremities and the face. A diagnosis of atypical GUILLAIN-BARRE syndrome was made. On 21 Jan 2010, the patient had difficulties with fluid seeping out through the corners of his mouth. The patient felt that hands were stiff and there was some pain in the right hand. HEENT exam showed bilateral facial droop. On 22 Feb 2010, the patient was doing well. Weakness was improving and numbness had been improved. The patient was able to swallow without difficulty. HEENT examination was unremarkable. It showed only some weakness in both facial nerves bilaterally. Also there was palatal elevation. The patient also had sleep apnea for which the patient was on Bi-PAP device. The patient was also given treatment with fentanyl patches. Final outcome of the events was reported as condition improving.