Age: 67.0
Sex: M
Vaccine: TD, TYP, YF, TD, TYP, YF
Symptoms: Hiccups, Muscle spasms, Respiratory distress
Clinical narrative: From initial information received on 11/6/03 from the CDC (Yellow Fever vaccine Working Group) regarding an adverse event occurring in an unspecified country it was reported that a 67 year old male patient, in preparation for a trip to a foreign country, received a Yellow Fever vaccine, a Diphtheria and Tetanus Toxoid vaccination and a Typhoid vaccination, lot numbers, manufacturers and routes and sites of administration unknown, on 9/4/03. The next day on 9/5/03, the patient developed unresolved hiccups with one episode of stomach spasms. The hiccups were unresolved for a week and the patient was admitted to the hospital for two days. The hiccups resolved. His medical records have been requested. No other information has been reported. It is unknown where the event occurred, however, for technical purposes box 1a of the CIOMS 1 form indicates a certain country.  Follow up on 12/01/2003: "From additional info received on 11/19/2003 from the CDC, the medical records of the pt were provided and confirmed that the events occurred in the USA.  The pt received a third dose of YF-VAX, Lot # UB563AA, SC in the right deltoid, a dose of TD ADS ADULT, lOT # u0830aa, IM in the left deltoid and a dose of Typhim VI, Lot # W1366, IM in the right deltoid on 09/04/2003.  24 hours later, the pt developed unrelieved hiccups and one episode of stomach spasms.  The hiccups continued unresolved for one week and were not responsive to outpt treatment with Thorazine and Reglan.  He was seen in the ER on 09/11/03 w/near respiratory distress due to hiccups.  He was given IV lidocaine, Phenergan and Ativan in the ER w/out effect.  He was then loaded w/Dilantin and admitted to the hospital on 09/11/03 with a diagnosis of intractable hiccups.  Upon admission, the pt appeared to be in respiratory distress due to severe spasming of the diaphragm, chest and abdominal wall.  He was kept on oral Dilantin and w/in four hours of admission, his hiccups initially resolved.  However, they recurred about 6-7 hours later.  Chest x-ray, EKG and lab evaluation were unremarkable.  Telemetry showed one episode of wide complex tachycardia lasting seven beats, but was otherwise sinus rhythm.  A cardiac consulation was done for moderate coronary calcification and an insignificant pericardial effusion.  The pt was given 50mg of IM Thorazine after one liter of normal saline.  He tolerated this well but two hours later was still hiccupping.  He was then given baclofen 10mg. orally for times a day and then redosed to 5mg orally 4 times a day b/c of sedation.  He had resolution of his hiccups and at the time of discharge on 09/13/2003 had been hiccup free for at least 12 hours.  In addition, the pts Remeron for depression was stopped b/c it had been associated with hiccups.  His discharge diagnosis was intractable hiccups, uncertain etiology.  Additional information received on 04MAY2004 from the CDC: The pt has received yellow fever vaccine two times previously without adverse effect. The pt has traveled. Admission lab results were provided. From additional information received on 18MAY2004 form the CDC , yello fever working group, it was reported on presentation to the Emergency Dept , the pt's vital signs were stable but he ws in "near respiratory distress".