Age: 40.0
Sex: F
Vaccine: FLUN3
Symptoms: Asthenia, CSF test abnormal, Chest pain, Confusional state, Encephalitis
Clinical narrative: A 39 year old pediatric nurse received FLUMIST vaccine on October 29, 2004. She was been well on the day she got vaccinated but a few days prior she had sore throat and son had a cold.  She developed body aches and low grade fever (described as flu-like) on October 31, 2004 (Day 2 following vaccine).   On Day 3 (11/01/04) she woke up feeling weak. By midday she developed fever, diaphoresis and pleuritic chest pain. She saw her primary care physician who diagnosed pneumonia clinically and placed her on Biaxin(Clarithromycin). The CXR however was negative.   On Days 6 and 7 (11/04/04-11/05/04), while still on Biaxin, she developed a sore throat and anterior lymph node swelling. This was followed by generalized body weakness on Day 9 (11/07/04). She woke up with a headache on Day 10 (11/08/04) which was unresponsive to acetaminophen and became severe by evening. She took 800mg Motrin which gave her no relief. Two hours after taking 2 sleeping pills she woke as a result of the headache. She called her primary care physician who advised her to go the ER, but she did not go.   The next day (Day 11- 11/09/04) she had a temperature of 101°F, was sweating and had pain all over. She presented to the ER of an affiliated hospital where she was found to be confused and vomiting and was admitted with a presumptive diagnosis of meningitis/encephalitis after the following lab data became available. A repeat CXR was without significant findings. Lumbar puncture showed: WBC- 480, Neutrophils-25, Monocytes-10, Lymphocytes-65; RBC-5; Protein-97 ; Glucose- 2. She was started on Acyclovir, Vancomycin, and cefuroxime.   We learned that she had a presumptive diagnosis of vaccine associated encephalitis late on the afternoon of 11/11/04 from a friend of hers who works in our office and we obtained permission through the friend to call the patient as we had no physician names. We obtained the primary physician contact information from the patient and information on the infectious disease consulting physician from her admitting doctor after a series of incorrect names given by the ward nurses. He provided us with the following lab data and confirmed that he and the primary physician had told the patient that they believed her illness may have been caused by FLUMIST.  On 11/12/04 we learned that the blood culture was negative as well as the spinal fluid viral culture. CSF HSV culture (PCR?) was negative. Blood was sent for VDRL and Lyme Antibody (results of these tests are pending). We asked about respiratory viral cultures and were told by the infectious disease physician that the culture was done, but checking with the nurses indicated that no respiratory cultures were done. We recommended that the culture be obtained as soon as possible. We obtained permission from the infectious disease consult and patient to retrieve residual CSF (0.5 mL) from the lab, and residual sera from admission (~0.5 mL). We checked the virology lab results via computer and determined the CSF viral culture was negative on 11/12 and 11/19/04. Viral culuture of 11/29/04 was positive for enterovirus. Respiratory viral cultures were never obtained. Her illness resolved quickly and she was discharged after 3 days of hospitalization with a working final diagnosis of post-vaccination meningitis.  Hospital obtained 14,000 doses of Flumist and had administered most of the vaccine as of 12/1/04. No other similar illnesses have been reported. From Discharge summary states abnormal cerebral spinal fluid, viral growth. msv From Medical records photophobia, sore throat, meningismis. msv