Age: 73.0
Sex: M
Vaccine: FLU3
Symptoms: Fall, Fatigue, Hepatic enzyme increased, Influenza, Influenza A virus test positive
Clinical narrative: This case was reported in a literature article and described the occurrence of vaccination failure in a 73-year-old male patient who received Flu Seasonal TIV Dresden. The patient's past medical history included prostate cancer and lymphoma. On an unknown date, the patient received Influenza vaccine at an unknown dose. On an unknown date, 30 days after receiving Influenza vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant), fever, muscle pain, sore throat, fatigue, mental status changes, fall, influenza A virus infection (serious criteria hospitalization) and mycoplasma infection (serious criteria hospitalization). The patient was treated with azithromycin and oseltamivir phosphate. On an unknown date, the outcome of the vaccination failure was unknown and the outcome of the fever, muscle pain, sore throat, fatigue, mental status changes, fall, influenza A virus infection and mycoplasma infection were recovering/resolving. The reporter considered the vaccination failure, fever, muscle pain, sore throat, fatigue, mental status changes, fall and influenza A virus infection to be possibly related to Influenza vaccine. It was unknown if the reporter considered the mycoplasma infection to be related to Influenza vaccine. Additional information received: This case was reported in a literature article and it described the occurrence of a vaccine failure in a 73-year-old male patient who had received an unspecified influenza vaccine (manufacturer unknown). The patient had a history of prostate cancer and lymphoma. No further information on the patient's concurrent medical conditions, medical and family history or concomitant medication was provided. On an unspecified date, the patient received one dose of an unspecified influenza vaccine (dosage unspecified; administration site and route unknown; batch number not provided). On an unspecified date, 1 month after the vaccination, the patient was admitted to hospital with a 1-day history of fever, muscle aches, sore throat and fatigue, followed by a change in his mental status and a 30-minute-long fall. Upon clinical examination his temperature was found to be 99.5 deg F, but the rest of the examination was unremarkable according to the authors. He was also noted to have elevated liver enzymes and creatinine kinase levels and had positive laboratory results for influenza A subtype 3 and mycoplasma. This was a serious case as the patient required hospitalisation. The results of a basic metabolic panel were reported to be normal by the authors, but the patient was found to have a mildly elevated white blood cell level, elevated liver enzymes (aspartate aminotransferase: 300; alanine aminotransferase: 100), increasing creatinine kinase level (from 3000 to 12000, that was thought to be abnormal for the duration of the fall by the authors). In addition to this, the patient tested positive for influenza A subtype H3 and mycoplasma immunoglobulin M antibody. The patient also underwent an electroencephalogram and a chest X-Ray with unremarkable results according to the authors. Treatment consisted of aggressive fluid resuscitation, azithromycin (dose unspecified) and TAMIFLU (dose unspecified). Outcome of the events was improvement within 3 days. In addition to this the authors also commented that his creatinine kinase level decreased after an unspecified period and that his renal function remained stable. The authors mentioned that the effectiveness of the vaccine might have been affected by an antigenic drift that had been observed in the previous seasons. The authors concluded that "due to drifted influenza A (H3N2) viruses, the Centers for Disease Control and Prevention has recommended influenza vaccine will protect against non-drifted circulating vaccine viruses and also it offers cross protection. Prescribing neuraminidase inhibitor antiviral medications for treatment and chemoprophylaxis as an adjunct to vaccination improve outcomes."