Sex: F
Vaccine: MEN
Symptoms: Blood lactic acid, Blood pH decreased, Brain natriuretic peptide normal, Carbon dioxide increased, Catheterisation cardiac abnormal
Clinical narrative: Initial unsolicited valid serious case report received from the literature on 14-Mar-2019. This case involves a 16 years old female patient who experienced anaphylactic reaction, syncope, pericardial inflammation, primary cardiac angiosarcoma, pulmonary metastases, hypotension, tachycardia, chest pain, diaphoresis, nausea, vomited, clammy, fell to the ground unresponsive, hepatomegaly to 4 cm below the costal margin, metabolic acidosis, a small right pleural effusion and altered mental status, while she received vaccine MENINGOCOCCAL VACCINE. The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. On an unknown date, the patient received a dose of suspect MENINGOCOCCAL VACCINE produced by unknown manufacturer lot number, Exp. Date, dose, route and administration site were not reported. On an unknown date, the patient developed serious anaphylactic reaction, syncope, pericardial inflammation (pericarditis), primary cardiac angiosarcoma, pulmonary metastases (metastases to lung), hypotension, tachycardia, chest pain, diaphoresis (hyperhidrosis), nausea, vomited (vomiting), clammy (cold sweat), fell to the ground unresponsive (fall), hepatomegaly to 4 cm below the costal margin (hepatomegaly), metabolic acidosis, a small right pleural effusion (pleural effusion) and altered mental status (mental impairment) following the administration of MENINGOCOCCAL VACCINE. The patient was hospitalized for these events. Relevant laboratory test results included: On an unknown date: Blood glucose level was 187 mg/dL, Blood lactic acid level was 4.5 mmol/L Blood pressure was 95/44 mmHg Body temperature was 36.4 degree Cel (97.5 degree F) Brain-type natriuretic peptide level was 42 pg/mL Carbon dioxide level was 38 Glasgow Coma Scale was 15 [15] Cortisol level was 49 ug/dL. Heart rate was 120 beats/min Oxygen saturation - was 95% on room air Respiratory rate was 23 breaths/min Troponin I level was 0.04 ng/mL White blood cell count was 28,800 /U. Other relevant test included: Chest radiography shows diffuse nodular opacities throughout both lungs. An electrocardiogram is performed that shows right axis deviation. A chest computed tomographic (CT) scan showed a mass centered in the epicardium of the right atrial wall involving the pericardium and extending through the myocardium to fill the right atrium. Her week 7 CT scan showed interval resolution in most of her pulmonary metastases and a decrease in primary tumor size by approximately 1 cm in every dimension. And laboratory results show venous pH 7.29. It was reported that, the patient immediately underwent pericardiocentesis and was slowly weaned off vasopressors. She underwent cardiac catheterization with biopsy, and once the diagnosis was confirmed, she was started on emergent stereotactic body radiotherapy directed toward the right atrium and single agent paclitaxel. She recently completed stereotactic body radiotherapy divided into 5 fractions and 12 weeks of chemotherapy with paclitaxel. Also reported that, she was started on an antidepressant medication, which she discontinued taking 3 weeks ago due to improvement in symptoms. An echocardiogram leads to the cause of her syncope. Final diagnosis was altered mental status, a small right pleural effusion, metabolic acidosis, hepatomegaly to 4 cm below the costal margin, fell to the ground unresponsive, became clammy, vomited, nausea, diaphoresis, chest pain, tachycardia, hypotension, pulmonary metastases, primary cardiac angiosarcoma, pericardial inflammation, syncope and anaphylactic reaction. The patient was treated with EPINEPHRINE, DIPHENHYDRAMINE, METHYLPREDNISOLONE, FAMOTIDINE and 4 L of isotonic fluids for anaphylactic reaction and PACLITAXEL for unknown indication and patient was initiated on a vasopressor drip to maintain blood pressures. At the time of reporting, the patient was recovering from pulmonary metastases, pulmonary lesions and several new lesions. And for rest all events outcome was not reported. List of documents held by sender: none. Sender's Comments: This case concerns a 16 years old patient who developed anaphylactic reaction, syncope, pericarditis, cardiac angiosarcoma, metastases to lung, hypotension , tachycardia ,chest pain, hyperhidrosis, nausea, vomiting, cold sweat, fall, hepatomegaly, pleural effusion, metabolic acidosis and mental impairment  after vaccination with MENINGOCOCCAL VACCINE. The time to onset is unknown. However, patient's medical condition at the time of vaccination and lab tests ruling out alternate etiologies were not reported. Based upon the reported information, the role of the vaccine cannot be assessed.