Sex: M
Vaccine: FLU3
Symptoms: Aphasia, Asthenia, CSF protein increased, Cataplexy, Disability
Clinical narrative: viral cataplexy/cataplexy; lose ability to walk; Guillain-barre syndrome; viral infection; body twitching; muscle contraction; jerking; myoclonus; muscle weakness; loss of responsiveness; fever; sporadic weakness; loss of sensation; This case was reported by a physician via call center representative and described the occurrence of cataplexy in a 57-year-old male patient who received Flu Seasonal TIV Quebec (FluLaval 2011-12 season) (batch number AFLLA687AA, expiry date unknown) for prophylaxis.   Previously administered products included Flulaval vaccine (2010-2011, batch number AFLLA591BA). Concurrent medical conditions included multiple allergies (a lot of), pneumonia (issues) and blood pressure high. Concomitant products included potassium nos (Potassium).   On an unknown date, the patient received FluLaval 2011-12 season. In March 2012, an unknown time after receiving FluLaval 2011-12 season, the patient experienced cataplexy (serious criteria hospitalization and GSK medically significant), unable to walk (serious criteria hospitalization and GSK medically significant), guillain barre syndrome (serious criteria hospitalization and GSK medically significant) and viral infection (serious criteria hospitalization). On an unknown date, the outcome of the cataplexy was not recovered/not resolved and the outcome of the unable to walk, guillain barre syndrome and viral infection were unknown.   It was unknown if the reporter considered the cataplexy, unable to walk, guillain barre syndrome and viral infection to be related to FluLaval 2011-12 season.  Additional details were provided as follows: This case was previously reported to a doctor. The patient had an aggressive immune system disorder. Concomitant medication also included high blood pressure medication. The patient received  a Fulaval 2011-2012 vaccine. In March 2012, he had a very rapid onset of symptoms that progressed over 6 months and that incapacitated him.    The symptoms required several hospitalizations for several weeks and numerous numbers of tests were done.   In March of 2012, he developed a viral severe cataplexy and Guillain-barre syndrome. It was a viral infection that made him lose the ability to walk. He had to go through rehabilitation to learn to walk and received treatment.  He was disabled and could not walk more than 10 feet. The patient had received some vaccines other than Flulaval and suffered from pneumonia issues in general but he did not have that information with him at the time of reporting. The reporter wanted to get more details about the H1N1 nuclear protein used within the Flulaval, as he believed that activated the viral infection. He also mentioned a vaccine made by different manufacturer that he received afterward, 2013-2014 MPV injector 94ZN4; expiry date 30th June 2014, a different set of expiration that he was not sure what it meant (26 July 2013). However, as per our sales data the batch number 94ZN4, corresponded to Flulaval 2013-2014.  Follow-up information received on 22nd December 2015: The patient's medical history included 2 paralysis episodes many years before vaccination with Flulaval, both triggered by high fever and infection. The patient had atypical cataplexy. This disorder started developing in March of 2012 in association with a fever inducing infection and Guillain-Barre syndrome. Related to criteria for autoimmune disorders was that the patient's immune system started getting very aggressive in his early teen years (poison ivy response and aggressive inflammatory reaction to mosquito bites).  He also developed many aggressive allergies over the years (particularly to drugs and medical tapes). The severity of his cataplexy symptoms was reduced by the off label use of the antidepressant Venlafaxine, a medication used in his case to significantly control, but not cure, his cataplexy symptoms. If he discontinued the use of this medication there was a rapid and dramatic increase in the frequency and severity of his episodes (status cataplecticus). His episodes were consistent and uniform when present. There were two primary types of triggering factors, fast (startle type factors) and slow (physical activity and limbic activity, strong laughter, fear or sadness), but the events, once triggered, begin in the same way, with the same end result and last about the same period of time on each occasion. During his events he was conscious, although he cannot speak or move for approximately 5 minutes. When he came out of his events it would be relatively sudden. History wise, starting in early March of 2012 he developed a fever of 100.4 during which he developed a sporadic weakness starting in his legs and progressing over a week to two weeks slowly up to his arms and head. The episodes of weakness were not full time but would cycle during the day. At the time he was not aware of any triggers or activities tied to the weakness events (knowledge of the consistent relation of such triggers or activities to the events had developed with his awareness of the disorder as it has progressed). Until he was sent to a neurological department in a hospital on an emergency basis he was unaware, that in addition to his weakness, he was losing pain, temperature and deep pressure sensation in a progressive manner over her body (Guillain-Barre syndrome diagnosed and treated). After being treated with IV IgG and high dose IV steroids for Guillain-Barre syndrome, his symptoms from Guillain-Barre syndrome slowly started to reverse. His weakness diminished but did not disappear. During rehabilitation immediately following the IgG and steroid treatments it seemed that the weakness was stabilized or diminishing but at the same time he was also developing sudden full body twitches that felt like a discourse of lightening or electrical shock shooting through his body and legs. These shock like events starting occurring more and more as time passed. The intensity gradually increased and ultimately would cause a sudden and rapid muscle contraction that would cause his legs and arms to suddenly uncontrollably jerk. Often throwing his body from his manual wheelchair. During his rehabilitation hospitalization he developed sporadic uncontrolled rhythmic myoclonic rhythmic contractions of his arms and legs. This sporadic myoclonic activity continued to present until he started treatment with Venlafaxine. By August of 2012 the sporadic weakness had progressively extended to include  his face and speech muscles during the events so he was then unable to move or talk during events. During his events he did not have difficulty breathing. He was generally able to swallow and control his tongue. During the development and progression of this disorder, his protein level in his cerebral spinal fluid progressively increased from March 2012 through his hospitalization, at another hospital. Since going to the another hospital, he  could not drive and required a wheelchair with a chest strap and lap strap for safety to avoid injury from collapse during events. He had very limited mobility in a standard wheelchair as sustained physical activity triggers events. He had variable events during a day, anywhere from 1 to 40 depending on his environment and his body status. Invariably he behaviourally isolated himself as much as possible to reduce the frequency of the events. For about a year or so after this medical matter started he was also able to control his eye blinks during events. This ability to blink during events had gradually been diminishing over the last year. He was not able to blink for about the first three minutes of his events. He had a very slow return of his blink control during latter part of his events. During events he could communicate using control of his breathing using puffs (1 puff  was yes, 2 was no, 3 was don't know). Since he could can control his breathing he now communicated by use of a mirror with yes and no questions (fogging the mirror with his breath). The patient continued to have multiple episodes of sudden onset of complete muscle weakness and loss of responsiveness. He requested himself  documentation regarding his health problems to the program. At the time of reporting, the patient was engaged in program for unknown disease.   Follow-up information received on 08Jan2024  In March 2012, an unknown time after receiving FLULAVAL, the patient experienced cataplexy.  Summary of changes: General tab (Report type, Reporter, Literature information), Event tab, Analysis tab, Additional information tab (VAERS ID) updated.