Age: 36.0
Sex: M
Vaccine: FLU3, MNQ, PPV, YF
Symptoms: Encephalitis, Eye pain, Headache, Hyperventilation, Liver function test abnormal
Clinical narrative: Initial report received on Nov 10 2005 from a consumer. A 35 year old male patient with a history of depression had received an intra muscular injection of Fluzone SV 2005 2006 USP, lot number U1823AA, in the right deltoid, his first subcutaneous injection of YF VAX, lot number UE664AB, in the right arm, his first intra muscular injection of another manufacturers Pneumovax vaccine, lot number 0749P, in the left deltoid and his first intra muscular injection of Menactra, lot number U1812AA, in the right arm on Nov 2 2005 at 16:00. Ten hours later he woke up with a temperature of 101 degree F that increased to 104.8 deg F. he went to the ER were he was treated with IV fluids and Tylenol. Blood test were performed. He was then sent home. The next day on 11/04/2005 at 16:00 he experienced nausea, blacking out, and back pain, He again went to the ER where he had additional blood test and a lumbar puncture. He was sent home with a prescription of Vicodin, He was on bed rest from 11/05/2005 to 11/08/2005 and was seen by the physician on 11/08/2005 at 10:00 am. On 11/09/2005 he was admitted to the clinic for infectious diseases and per the reporter, was diagnosed with yellow fever. Additional information and hospital records were received on 11/11/2005. Per the reporter, as of 14:45 on 11/10/2005 the patient was doing better and will be discharged to home from the clinic on 11/10/2005. The reporter stated that the patients predominant symptoms were sever headaches and neck pain with pain in his eyes. He was also sensitive to light. She stated that for the first two visits to the emergency room the patient was told it was probably a reaction to the flu vaccine and was told to rest and take Tylenol. She stated the patient was diagnosed at the clinic as having a mild case of yellow fever and was now feeling better since they controlled the pain.  Hospital records received on 11/11/2005 indicated the patient was admitted to the hospital on 11/09/2005 with a complaint of headache that was occipital in nature with no radiation with pain and pressure behind his eyes. He had not had any episodes of blurred vision. His pain started the morning of 11/3/2005 along with a fever. The patients wife stated that the patient had syncopal episode on Friday 11/04/2005 in the ER possibly related to hyperventilation. The patient stated the headache was not getting better. His alleviating factors included lying down and avoiding light. The aggravating factors included moving and light. Physical Neurological examination was negative. Laboratory data was reported as follows (date of laboratory work not reported), white blood count 7.8, platelet count 283, hemoglobin 15.7, hematocrit 43.9, sodium 137, potassium 3.1, chloride 102, bicarbonate 25, blood urea nitrogen 9, creatinine 1, glucose 110, calcium 9.4, international normalized ratio 0.99, partial thromboplastin time 32.1. Lumbar puncture completed in the ER on 11/04/2005 revealed normal cerebrospinal fluid. The patient had an Anesthesia consult that ruled out a spinal headache, and a neurology consult that ruled out any neurological component to the headache. He had a magnetic resonance imaging scan that was normal with no acute changes which would suggest etiology of the headache. His diagnosis was headache most likely due to post viral encephalitis or post spinal tap. The patient refused to leave the hospital and wanted to be admitted. He was admitted for observation and was started on Robaxin 750 mg four times a day, potassium chloride CR 20 mEq, Norco 10/135 mg as needed. He had blood cultures taken, sedimentation rate, liver function test and Prothrombin time. The patient had a Infectious Disease consult on 11/10/2005. It was reported that twelve hours after the vaccination on 11/02/2005 the patient developed occipital headaches and was admitted to the hospital with a high grade fever of 104.0 deg F. The fever de-effervesced itself. His headaches were attributed to post lumbar puncture headache. The patient was treated on 11/09/2005 with additional medications of Motrin and Metoclopramide. The recommendation of infectious disease was that the patient could be sent home with reassurance that his headache will resolve in one week, these symptoms are most likely due to yellow fever vaccination. The patient was advised to take off from work for one week to ten days. He was told if his headaches persisted beyond one week he should see his neurologist for a serum patch to treat post spinal tap headache. His liver function test was found to be mildly elevated which can be secondary to vaccination. The patient was discharged in stable condition, afebrile and with pain under control. The discharge medications were Motrin 400 mg by mouth three times a day and wean off as needed. Metoclopramide 5 mg by mouth before meals and at bedtime as needed and Norco 325.5 mg one tablet by mouth every six hours as needed. The patient was to follow up with his primary care physician in one week. Further information obtained via telephone call with the physician on 11/11/2005 reveals that the patient was not diagnosed with the disease yellow fever. He was diagnosed as Adverse reaction to vaccine. The physician states the cerebral spinal fluid results were no cells present. It was reported that the patient's recovery status was described as fine with a little remaining headaches.