Sex: F
Vaccine: TDAP, UNK, UNK, UNK, UNK
Symptoms: CSF protein increased, CSF red blood cell count positive, Guillain-Barre syndrome, Hyporeflexia, Immunoglobulin therapy
Clinical narrative: Guillain Barré syndrome; diminished deep tendon reflexes; This case was reported in a literature article and described the occurrence of guillain barre syndrome in a 19-year-old female patient who received HAB (Hepatitis A and Hepatitis B vaccine) for prophylaxis.   Co-suspect products included DTPa (Reduced antigen) (Tdap Vaccine) for prophylaxis, Men ACWY-CRM NVS (Meningococcal ACWY Vaccine (potential Menveo)) for prophylaxis, ADENOVIRUS VACCINE for prophylaxis and INFLUENZA VACCINE (LIVE ATTENUATED INFLUENZA VACCINE) for prophylaxis.   On an unknown date, the patient received Hepatitis A and Hepatitis B vaccine at an unknown dose, Tdap Vaccine at an unknown dose, Meningococcal ACWY Vaccine (potential Menveo) at an unknown dose, ADENOVIRUS VACCINE at an unknown dose and LIVE ATTENUATED INFLUENZA VACCINE at an unknown dose. On an unknown date, 9 days after receiving Hepatitis A and Hepatitis B vaccine, Tdap Vaccine and Meningococcal ACWY Vaccine (potential Menveo), the patient experienced guillain barre syndrome (serious criteria hospitalization, GSK medically significant and other: as per reporter) and diminished reflexes (serious criteria hospitalization). The subject was treated with immunoglobulins nos (Intravenous Immunoglobulin). On an unknown date, the outcome of the guillain barre syndrome and diminished reflexes were unknown.   The reporter considered the guillain barre syndrome and diminished reflexes to be possibly related to Hepatitis A and Hepatitis B vaccine, Tdap Vaccine and Meningococcal ACWY Vaccine (potential Menveo).  Additional details were reported as follows: This case was reported in a literature article and described the occurrence of guillain barre syndrome (GBS) in a 19 year old female patient who was vaccinated with unspecified adenovirus vaccine; unspecified combined hepatitis A and B vaccine; unspecified live attenuated influenza (LAIV), unspecified meningococcal conjugate vaccine (MCV4) and unspecified tetanus, diphtheria & acellular pertussis vaccine (Tdap) vaccines (manufacturer unknown for all vaccines) for prophylaxis.   The patient was the part of the observational study that aimed to investigate adverse event (AE) reports following the adenovirus vaccine submitted to the Vaccine Adverse Event Reporting System (VAERS). They searched the VAERS database reports among persons who received adenovirus vaccine during 1st October 2011 through 31st July 2018 including participants in a military observational study. [In this study, they identified those reports filled from 24th October 2011 to 5th October 2012, an FDA-mandated, post marketing military observational study was conducted using the Surveillance System database. This study compared 100,000 recruits exposed to the adenovirus vaccine with a historical unexposed cohort and identified statistical signals for psoriasis, anaphylaxis and other hypersensitivity reactions as emergent AEs possibly related to vaccination. During the study period, VAERS received a total of 100 reports following adenovirus vaccine; among all reports, the earliest vaccination date with the adenovirus vaccine we identified was November 9, 2011]. The patient was from the military observational study. The patient had no medical history. No information on patient's family history or concomitant medication was provided.  On an unspecified date, the patient had received unspecified adenovirus vaccine; unspecified combined hepatitis A and B vaccine; unspecified live attenuated influenza (LAIV), unspecified meningococcal conjugate vaccine (MCV4) and unspecified tetanus, diphtheria & acellular pertussis vaccine (Tdap) vaccines (administration route and site unspecified, dosage unknown; batch number not provided for all). The age of vaccination was not provided. On an unspecified date in 2013, 9 day after vaccination, the patient had diminished deep tendon reflexes (DTR). The cerebrospinal fluid (CSF) showed 2483 red blood cell count elevated protein (traumatic LP. No records on electromyogram (EMG) and nerve conduction (NCS) (as discussed with the neurology team). The patient was diagnosed with GBS (Brighton level 3). [In this study, the main diagnosis for each report was categorized into a MedDRA System Organ Class (SOC) grouping. Reports suggestive of anaphylaxis or GBS were further classified using the Brighton Collaboration criteria or a physician's diagnosis. Brighton criterion for cytoalbuminologic dissociation was CSF protein elevation above laboratory normal value and CSF total wbc count less than 50 cells per ul.]. This case has been considered as serious due to the hospitalization and as per reporter. [In this study, all patients were hospitalized. Reports are classified as serious based on the Code of Regulations if one of the following was reported as death, life-threatening illness, hospitalization or prolongation of hospitalization, permanent disability, or congenital anomaly]. The patient received treatment with intravenous immunoglobulin (IVIG). The outcome of event was not reported. [In this study, all patients were recovered, however, four required ICU admission and were intubated]. The author commented, "In addition, 95 percent of the adenovirus vaccine reports documented co-administration of other vaccines and 50 percent reported co-administration of penicillin G (or other antibiotic if allergic to penicillin) according to standard protocol in this military population. The investigators of the earlier military observational study also commented that concurrent vaccine exposures in the recruit population was an important limiting factor for attributing the statistical signaling outcomes including psoriasis, anaphylaxis and other hypersensitivity reactions as possibly related to the vaccine". The author concluded "The reporting rate for serious AEs was higher than with other vaccines administered in the comparison military recruit population (39 percent vs 18 percent however, we identified no unexpected or concerning pattern of adenovirus vaccine AEs. Co-administration of vaccines and IM Pen G was commonly reported in this military population. These exposures may have contributed to the GBS and anaphylaxis outcomes observed with the adenovirus vaccine. Future adenovirus vaccine safety studies in a population without these co-administrations would be helpful in clarifying the vaccine's safety profile". This is 1 of the 19 valid cases reported in this literature article.      Lab Comments: No records on electromyogram (EMG) and nerve conduction (NCS) (as discussed with the neurology team). The patient was diagnosed with GBS (Brighton level 3).