Sex: M
Vaccine: HIBV
Symptoms: Clavicle fracture, Coma scale abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Endotracheal intubation
Clinical narrative: 50-year-old male was administered the postsplenectomy vaccines (Haemophilus b Polysaccharide Conjugated Vaccine, Meningococcal Polysaccharide Vaccine; Initial information has been received from the authors of a published literature article titled as stated below, regarding a 50-year-old male patient. The patient presented with altered mental status, after driving his motorcycle into a tree. His vital signs were within normal limits and his initial Coma Score of 13 quickly improved. His past medical history revealed alcohol use disorder but no anticoagulants. He complained of right shoulder and back pain. The patient had a FAST that was negative and was stable enough to undergo chest and abdominal computerized tomography (CT) with IV contrast imaging studies, which revealed fractures of right ribs 35, right midclavicular fracture displacement, right pneumothorax, and T59 spinous process fractures. Both the focused abdominal sonography for trauma (FAST) and CT imaging studies did not show any indications of splenic injury. The patient underwent a right tube thoracostomy with a resolution of the pneumothorax and was admitted to the trauma service for pulmonary optimization, control of pain, and treatment of his injuries.  On hospital day 3, the patient underwent placement of a right paravertebral subcutaneous pain pump for significant ongoing pain associated with his right-sided rib fractures. On day 5, the trauma team was called to the bedside for acute hemodynamic compromise and the patient was found to be diaphoretic, hypotensive, tachycardic, and have altered mental status. He was intubated for inability to protect his airway and fluid resuscitation was initiated. The results of a stat bedside FAST examination revealed a large amount of fluid in the abdomen and a point of care hemoglobin was 5 (units not reported), down from 11 (units not reported), earlier in the day. A Massive Transfusion Protocol (MTP) was initiated, and the patient underwent an emergent laparotomy. In the operating theater, several liters of dark blood were evacuated from the abdomen and a hilar splenic injury was identified. The spleen was removed. Due to the patient being in extremis, damage control laparotomy was performed, and a negative pressure wound vacuum dressing was placed and ongoing resuscitation continued.  In the Trauma unit, his blood pressure, fluid requirements, and pH stabilized over several hours while his urine output remained poor. On postoperative day one (POD-1) he was re-explored with no additional findings and a second negative pressure wound vacuum dressing was placed because of ongoing swelling and edema. On POD-4, the patient underwent a third laparotomy. No additional findings were encountered, the edema had improved, and after abdominal washout, the abdomen was closed. His course was complicated by acute kidney injury requiring hemodialysis.   Then, the patient was administered the post-splenectomy vaccines haemophilus b conjugate vaccine (meningococcal protein conjugate) (manufacturer unknown) administered for prophylaxis at the age of 50 years old (product use issue) (strength, dose, anatomical location, lot #, expiry date, and route of administration were not provided) on postoperative day 14. Over the next two weeks, his renal function improved, and he was discharged in a stable condition.  A copy of the published article is attached as further documentation of the patient's experience.