Age: 31.0
Sex: M
Vaccine: FLU3, HEP, MNQ, YF
Symptoms: West Nile virus test negative
Clinical narrative: This serious case was reported by a health care professional to the Centers for Disease Control and Prevention (CDC), who forwarded the information on 09 January 2009. VAERS reference number 327875. A 31-year-old male patient, had received a first intramuscular left arm injection of MENACTRA (lot number U2669AA); a tenth intramuscular right arm injection of FLUZONE 2009-2009 (lot number U2750AA); a first subcutaneous left arm injection of YF-VAX vaccine (lot number UF426AA); and a first intradermal right arm injection of ENGERIX B (manufacturer GlaxoSmithKline, lot number AHBVB670AA) on 18 September 2008 at 08:15 am. On 27 October 2007 the CDC received medical records that revealed the patient had pre-existing medical history of lower back disease due to lumbar disk herniation, and a meniscal tear in the left knee times two. The records also revealed, that the patient a had recently traveled abroard with diarrheal illness followed by two to four weeks of finger tip numbness which resolved over the past six weeks. On 29 September 2008, i.e., eleven days after receiving the MENACTRA, FLUZONE, YF-VAX and ENGERIX B, the patient presented to the emergency room with a two day history of worsening ascending lower and upper extremity weakness with abnormal sensation. He also had tightness and tingling of his fingertips, elbow and knee. He was unable to rise from a squat, and had experienced an episode of a fall. The patient was admitted to the hospital and physical examination revealed ascending stocking glove neuropathy with weakness and decreased vibratory sensation in his hands and feet. He had swallowing difficulties as well. The patient was treated with IVIG 2gm/kg (175gm) given over three days (30 September 2008 to 02 October 2008) and IVIG 1gm/kg (90 gm) given over two days (04 October 2008 to 05 October 2008). The CDC received medical records for date of service from 29 September 2009 to 08 October 2008 revealing a diagnosis of GUILLIAN BARRE Syndrome (GBS). Relevant diagnostic tests/laboratory data during hospitalization included cerebrospinal fluid culture that was negative and contained 127 red blood cells (RBC), 2 white blood cells (WBC), and revealed the protein level at 42, and glucose level at 51. An electromyelogram (EMG) on 30 September 2008 was supportive of primary demyelination with mildly prolonged distal and F-wave latencies, borderline velocities in scattered distribution and prolonged blink latencies consistent with GBS. From the medical records the CDC had received on 27 October 2008, the patient had additional diagnostic laboratory values of increased monocytes% to 14.3, and increased phosphorous level of 4.8. A west Nile virus IgG was 0.08, and west Nile virus IgM was 0.02. A Magnetic Resonance Image (MRI) and Magnetic Resonance Angiogram (MRA) were normal. The recovery status of the patient was reported as unknown. documents held by sender: None. 1/28/2010 Last seen in clinic 3/5/09. At that time continued to report fatigue, fine moter deficits, numbness in feet. On exam found to have reduced reflexes and sensations. Expected to continue improvement over the next 12 months with likely no residual deficits.