Sex: M
Vaccine: FLUX, HEP, HEPA, TDAP, UNK, UNK, UNK, UNK, VARCEL
Symptoms: CSF protein increased, CSF white blood cell count negative, Electromyogram abnormal, Guillain-Barre syndrome, Hyporeflexia
Clinical narrative: Guillain Barré syndrome; diminished deep tendon reflexes; Inflammatory neuropathy; This case was reported in a literature article and described the occurrence of guillain barre syndrome in a 20-year-old male patient who received Hepatitis B vaccine for prophylaxis.    Co-suspect products included Flu unspecified (Influenza vaccine) for prophylaxis, Men ACWY-CRM NVS (Meningococcal ACWY Vaccine (potential Menveo)) for prophylaxis, DTPa (Reduced antigen) (Tdap Vaccine) for prophylaxis, Hepatitis A vaccine for prophylaxis, Measles Mumps Rubella for prophylaxis, live varicella virus vaccine (Varicella Vaccine) for prophylaxis, adenovirus vaccine for prophylaxis and poliomyelitis vaccine (Poliovirus Vaccine Inactivated) for prophylaxis.   The subject's past medical history included upper respiratory tract infection, sinusitis (2 week prior to the onset of weakness) and weakness.   On an unknown date, the patient received Hepatitis B vaccine at an unknown dose, Influenza vaccine at an unknown dose, Meningococcal ACWY Vaccine (potential Menveo) at an unknown dose, Tdap Vaccine at an unknown dose, Hepatitis A vaccine at an unknown dose, Measles Mumps Rubella at an unknown dose and frequency, Varicella Vaccine at an unknown dose and frequency, adenovirus vaccine at an unknown dose and frequency and Poliovirus Vaccine Inactivated at an unknown dose and frequency. On an unknown date, 33 days after receiving Hepatitis B vaccine, 32 days after receiving Influenza vaccine, Meningococcal ACWY Vaccine (potential Menveo) and Tdap Vaccine and 26 days after receiving Hepatitis A vaccine, the patient experienced guillain barre syndrome (serious criteria hospitalization, GSK medically significant and other: as per reporter), diminished reflexes (serious criteria hospitalization) and neuropathy (serious criteria GSK medically significant). The subject was treated with immunoglobulins nos (Intravenous Immunoglobulin). On an unknown date, the outcome of the guillain barre syndrome, diminished reflexes and neuropathy were unknown.   The reporter considered the guillain barre syndrome, diminished reflexes and neuropathy to be possibly related to Hepatitis B vaccine, Influenza vaccine, Meningococcal ACWY Vaccine (potential Menveo), Tdap Vaccine and Hepatitis A vaccine.  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 20 year old male patient who was vaccinated with unspecified adenovirus vaccine; unspecified inactivated influenza (IIV), unspecified inactivated poliovirus (IPV), unspecified meningococcal conjugate vaccine (MCV4); unspecified tetanus, diphtheria & acellular pertussis vaccine (Tdap) vaccines; unspecified hepatitis B; unspecified measles mumps and rubella vaccine (MMR), unspecified varicella vaccine and unspecified hepatitis A (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 for reports among persons who received adenovirus vaccine during 1st October 2011 through 31st July 2018 including participants in an observational study. [In this study, they identified those reports filled from 24th October 2011 to 5th October 2012, an FDA-mandated, post marketing observational study was conducted using the Surveillance System database. This study compared 100,000 patients 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 observational study. The patient had the history of the upper respiratory tract infection (URTI) and sinusitis 2 week prior to the onset of weakness. No information on patient's family history or concomitant medication was provided.  On an unspecified date, the patient had received unspecified hepatitis B; unspecified measles mumps and rubella vaccine (MMR), unspecified varicella vaccine ), (administration route and site unspecified, dosage unknown; batch number not provided for all). The age of vaccination was not provided. On an unspecified date, 1 day after previous vaccination, the patient had received unspecified adenovirus vaccine; unspecified inactivated influenza (IIV), unspecified inactivated poliovirus (IPV), unspecified meningococcal conjugate vaccine (MCV4); 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, 6 day after previous vaccination, the patient had received unspecified hepatitis A (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 2012, 33 days after receiving Unspecified Hepatitis B vaccine, Unspecified MMR, Unspecified Varicella vaccine, 32 days after receiving Unspecified Adenovirus vaccine, Unspecified IIV vaccine, Unspecified IPV, Unspecified MCV4 and Unspecified Tdap Vaccine and 26 days after receiving Unspecified Hepatitis A vaccine, the patient had diminished deep tendon reflexes (DTR). The cerebrospinal fluid (CSF) 2 white blood count (WBC) which was CSF protein was elevated. The electromyogram (EMG) and nerve conduction (NCS) study showed inflammatory neuropathy. The patient was diagnosed with GBS (Brighton level 1). [In this study, the main diagnosis for each report was categorized into a 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. [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 patient population. The investigators of the earlier observational study also commented that concurrent vaccine exposures in the patient 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 patient 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 patient 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: The electromyogram (EMG) and nerve conduction (NCS) study showed inflammatory neuropathy.