Age: 18.0
Sex: M
Vaccine: FLU3
Symptoms: Abdominal distension, Abdominal pain, Abdominal tenderness, Albumin globulin ratio, Albumin urine
Clinical narrative: Initial report received on 10 May 2007 from the patient's parents. A healthy 17-year-old male patient with no concurrent illnesses, no known allergies or past medical history, had received a right arm dose of FLUZONE SV '2005-2006' USP, lot number U1882AA on 28 November 2005 while in the military. The patient denied any previous adverse events with any prior vaccinations. His last vaccinations were given in August or September (type of vaccine, date and year not provided). The following day after receiving the influenza vaccination, the patient woke up with swelling of his eyes which decreased by mid-day. He complained of nausea and abdominal pain. The mother reported the patient had gained 30 pounds. Ten days later, the patient had developed a "scaly, pruritic rash on palmar aspect of left hand" and was evaluated by a "medic" and treated with topical steroid cream. At that time, the patient's weight was documented as being 25 pounds above his baseline. As insect bite was considered, but there was no visible evidence of a bite. Within two weeks post-vaccination, the patient's "buddies" had difficulty waking him up in the mornings, he had begun snoring, had continued swollen eyes each morning, gained greater than 20 pounds and his urine was "foamy". On 18 December 2005, 20 days post-vaccination, the patient was admitted to the military hospital for vomiting and acute abdominal pain (10/10). He was afebrile and had ascites with abdominal distention and tenderness. The patient also had bilateral pleural effusion. Laboratory data revealed "white blood cell count 8.2, creatinine 1.3, total protein 3.8, albumin 0.9, A/G ratio 0.3, AST 49, GGT 8, and LDH 205." The "electrolytes, ALT, and bilirubin/alk phos were all normal." Three liters of fluid was drained from the abdomen and the patient underwent emergent appendectomy, biopsy of small bowel, and removal of a small portion of the large intestine. Per the reporter, analysis of the ascites fluid, appendix and small bowel were all negative. The patient was released from the hospital. On 23 December 2005, 25 days post-vaccination, the patient presented to a civilian hospital with diffuse edema, dyspnea, weight gain, and was admitted and diagnosed with "overt nephrotic syndrome" and kidney failure. At that time, his urine protein was 130 grams/24 hours. A renal biopsy performed in December 2005, revealed "while several of the segmental lesions are tip lesions, other segmental lesions are not as well defined and may include perihilar sclerosis, so while the features are most consistent with a tip lesion, variant of "FSGS" (focal segmental glomerular lesions), this lesion is considered "FSGS,NOS (not otherwise specified). There is no evidence for an acute glomerulonephritis or immune complex-related conditions. The tubulointerstitial and vascular compartments appear normal( through arteries are not well sampled)." Sometime in December 2006, the patient was started on hemodialysis. The patient was subsequently transferred to another facility sometime in January 2006, with anasarca, 4+ weeping edema of the lower extremities and cellulitis, periorbital edema, and bilateral pleural effusion with bibasilar atelectasis. During the first three weeks at this facility, the patient was treated with intravenous steroids, Cyclosporine, intravenous albumin, Lasix and antibiotics. After treatment, the patient's edema and weight dramatically improved. The patient was subsequently released from the hospital. Despite further treatment, the patient's kidney disease steadily declined to chronic kidney disease stage V. On 30 March 2007, 122 days post-vaccination, the patient was emergently admitted to the hospital with fluid overload, respiratory distress (oxygen saturation 94%) and malignant hypertension. Five liters of fluid was removed from the patients body. Per the reporter, the patient's currently received dialysis three to four times a week and continues with myalgia, new onset migraines, pleural effusions, insomnia, anuria, abdominal pain, fatigue, and recurrent rashes. The patient has severe straie from the whole body edema. Per the reporter, the patient suffered pulmonary edema, chest pain, abdominal pain and cough from a delay in dialysis treatment, pitor, lisinopril, losartan, "nephrocap" (nephrocaps), Zantac and atenolol. The patient is being considered for possible kidney transplant. The patient has not recovered.   1/26/09 Received medical information from VHC from 2007. FINAL DX: end stage renal disease, dialysis dependent & awaiting transplantation secondary to focal segmental glomerulosclerosis. Records reveal patient experienced bilateral eye lid swelling 1 day after flu shot 11/28/05; dry scaly rash on had/fingers; hand swelling; 26# wt gain by 12/8/05; difficult to arouse, trouble running, foamy urine approx 2 wks s/p vaccination; abdominal pain & vomiting 12/18 & presented to ER.  Appendectomy done & 3L of fluid removed from abdomen.  Symptoms evolved to progressively worsening swelling & abdominal pain diagnosed as nephrioic syndrome w/anasarca approx 1 mo after vacccination.  Condition deteriorated w/multiple re-hospitalizations & started hemodialysis 12/2006. Continued w/N/V/D, HTN, abdominal pain, myalgias, arthralgias, difficulty sleeping, HA, anuric, chronic rashes & urticaria, extreme fatigue.