Age: 17.0
Sex: F
Vaccine: DT, HEPA, TYP, YF
Symptoms: Malaise, Monocytosis, Muscular weakness, Nausea, Neutropenia
Clinical narrative: From initial information received on 06/May/2004 through an enhanced surveillance program conducted by the Centers for Disease Control and Prevention (VAERS number 217755) regarding an adverse event occurring in the U.S.A., it was reported that a 17-year-old female patient received the following vaccinations in preparation for a mission to Peru: YF-VAX, lot number and routed of administration unknown, a dose of TYPHOID VACCINE, lot number, manufacturer and route of administration unknown, a dose of TETANUS TOXOIDS, lot number, manufacturer and route of administration unknown on 11/Feb/2004. One week after the receipt of the vaccines on 18/Feb/2004, the patient was admitted to the hospital Intensive Care Unit with a one to two day history of weakness in walking, a general ill feeling and shortness of breath. She was started on BiPAP for decreased respiratory function. She was seen by a neurologist and her diagnosis was thought to be most likely GBS, but it was an unusual presentation for such. Myasthenia gravis antibodies were negative. CBCs were predominantly within normal range. WBC was in the 3-4 range with about 30% neutrophils and 40 to 50 % lymphocytes. HGB was stable throughout. Iron and iron binding studies were normal. Vitamin B12 was normal. Sed rate was normal. UA was normal. Blood gas was 7.39 PH, pACO2 was 44, pAO2 was 105 prior to starting BiPAP. Electrolyte panels were normal including LFTs. CPK was normal. TSH was normal. Protein electrophoresis was normal. Spinal tap had 1 RBC, 1 enucleated cell, 24 protein, glucose of 58 and negative culture. RPRs were nonreactive. Lead test was normal. EMG was normal. CXR was negative. EKG did show some sinus arrhythmia, but due to hospital course and clinical suspicion, Guillain-Barre variant was the most likely diagnosis. The patient was treated with IV IG therapy for the presumed GBS. She steadily improved and was transferred from the ICU to the medical floor. Respiratory function improved. She had some peripheral weakness and decreased reflexes so Guillain-Barre variant was thought to be the most likely diagnosis. She was weaned off of BiPAP. She was discharged on 23/Feb/2004, five days after admission with adequate pulmonary function although still decreased from presumed baseline. Her activity was as tolerated with outpatient Physical and Occupational Therapy follow-up, and she had a wheelchair to use as needed. The patient's medical doctor was spoken to on 18/Mar/2004, about one month after discharge and he said she had not completely resolved her weakness and still had poor endurance. The labs were sent to the CDC at Ft. Collins and the results are as follows: a CSF sample was collected on the day of onset, 18/Feb/2004. The sample was negative for Yellow-Fever vaccine virus in  TaqMan PCR and also negative for Yellow-Fever IgM antibody on ELISA testing. It was suggested to submit a convalescent serum sample to determine whether the patient developed an appropriate response to the vaccine. On 06/May/2004, the treating physician agreed to obtain a convalescent serum sample for the CDC Ft Collins in the next week or so. He has not seen the patient in several weeks and will contact the mother to bring her in to obtain the sample. From additional information received on 22/Jan/2004 from another manufacturer, their reference number WASE0406USA01554) was provided. No new medical information was reported. From additional information received on 15/Nov/2004 it was reported that the YF-VAX vaccine lot number UE059AA was administered subcutaneously in the right arm, the TYPHIM VI vaccine, lot number X0481 was administered intra-muscularly in the left deltoid, the HEPATITIS A VACCINE, lot number VHA713A9 was administered intramuscularly in the right deltoid and the TD ADS ADULT vaccine, lot number U0998AA was administered intramuscularly in the left deltoid. According to the admission note provided, the patient was walking up stairs and doing her work. She had a general feeling of not feeling right the day preceding admission. She had significant decrease in her lung function and increase in work of breathing and feeling short of breath. The patient had quite an uncomfortable sensation in her anterior chest and abdomen that she described as a feeling of needle pricks or tingles that radiated up her back. The symptoms seem to come on with eating. She seems to have some mild stomach cramps and yesterday felt lightheaded but was not syncopal. Today the patient has a mild headache and has felt queasy. The patient does have some Raynaud phenomenon for which she takes occasional Naprosyn. Her neurologic evaluation included a significant differential for neuromuscular weakness, of which Guillain Barre was felt to be the most likely. The patient was treated with IV IG therapy for the presumed Guillain Barre. Over the hospitalization the patient showed steady improvement every day. She continued to show improved respiratory function and was discharged home on 23/Mar/2004. From additional information received on 22/Nov/2004 through an enhanced surveillance program conducted by the Centers for Disease Control and Prevention (VAERS number 217755), it was reported that the patient required outpatient physical therapy for residual weakness at the time of hospital discharge, but was mostly recovered. Per the reporter, the patient fully recovered from the events.