Age: 64.0
Sex: M
Vaccine: HEPA, TYP, YF
Symptoms: Rash erythematous, Renal failure, Sepsis, Shock, Thrombocytopenia
Clinical narrative: From initial information received on 11/9/04 from the CDC regarding an adverse event occurring in the USA, it was reported that a 64 year old male patient preparing for a fishing trip overseas received YF-VAX, lot number UE265AA, administered SC, TYPHIM Vi, lot number AP0862, administered IM, and HAVRIX, lot number 0085P, administered IM on 10/20/04. Two days later, on 10/22/04, the patient developed nausea, vomiting, and diarrhea which lasted for one week. He went fishing and traveled and upon returning home became confused and hypotensive. He was admitted to the hospital on 10/29/04 with septic shock and placed in the ICU. The patient had fever, but the onset date was not reported. It was reported that the patient was improving and no longer requires a ventilator and was moved to an intermediate care unit. From additional information received on 30/Nov/2004 from the CDCP, it was reported that the patient was admitted to a hospital for confusion, hypotension and septic shock, on 20/Oct/2004. The patient has one renal and liver involvement. All cultures were negative and no etiology for the illness has been determined. Reportedly, the data at this point tell nothing about why this patient suffered an adverse event. The kinetics of disease onset (two days post viaccination), is far too rapid for it to be due to immunopathology mediated by the 7 cell responses. In addition there is no similar data (with the VZV reconbinants) from normal Yellow Fever vaccine responses. There is some bulk T cell activation data, and there is still a large frequency of activated T cells, maybe up to 20A. This is unusual compared to normal responses (in a younger cohort). This report was considered as a possible case of Yellow Fever Vaccine Associated Viscerotrophic Disease disease by the CDC. From additional information recevied on 01/Jan/2005 from the Yellow Fever Work Group Meeting minutes, it was reported that the following were discharge diagnois 2a sepsis, 2a possible. YFVAVD is disseminated intravascular citing (INC) 4. Thrococytopenia, 5>, Fever 4>, arotia of chronic inflammation % hypertension 8 delirum 5> febaceous cyst on his back 10> Acute renal failure. The patient recovered and was discharged from the hospital on 10/Nov/2004. From additional information received on 27/Jan/2005 from the CDCP, it was reported that this 64 year old male presented to his primary medical doctor on 27/Oct/2004 with a history of five nights of fever and chills, urinary frequency and one day of nausea and vomiting and diarrhea. He had no abdominal pain or dysuria. The onset of symptoms was reported as 23/Oct/2004. Upon physical examination, the patient's blood pressure was 90/75 and his temperature was 101.4 degrees Fahrenheit. He was hypokalemia and a chest x-ray was clear. The primary physician diagnosed viral gastroenteritis. The patient returned to his primary medical doctor the following day on 28/Oct/2004 with increased weakness, diarrhea, vomiting and confusion. His blood pressure at that timeo was 70/80 and his temperature was 100.3 degrees Fahrenheit. He had mild erythematous rash on his legs and trunk and petechia on his face. The patient was admitted to the hospital for dehydration. On the first day of admission, the patient decompensated quickly and was transferred to the intensive care unit. Initial treatment included levaquin and fomyn after blood culter were contained, and volume rescurication with vasopresci. He had increased liver function tests. His respisratory function was intact and intubation was not required. Eight dose of Solu-Medrol were given between 29/Oct/2004 and 01/Nov/2004. The patient improved and was discharge on 10/Nov/2004 in stable condition, with residual weakness and an elevated creatinine of 2.0. He was discharged on clindamycin (for an infected sebateous cyst) and was to receive in home physical therapy for improving strength.