Sex: F
Vaccine: RAB
Symptoms: Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Echocardiogram abnormal, Ejection fraction normal
Clinical narrative: acute pulmonary embolism/ Submassive pulmonary embolism/ bilateral proximal pulmonary embolism; pleuritic chest pain; Initial information received on 23-Jun-2021 regarding an unsolicited valid serious case from the other health care professional issued in a literature article.  This case involves an 80 year old female patient who experienced acute pulmonary embolism/ submassive pulmonary embolism/ bilateral proximal pulmonary embolism (pulmonary embolism) with symptom of pleuritic chest pain (pleuritic pain) while receiving RABIES VACCINE and RABIES IMMUNOGLOBULIN [HUMAN ANTIRABIES IMMUNOGLOBULIN].  The patient's past medical history included scratched and possibly beaten by a bat at her home (Animal bite) nine days prior to start of events.  At the time of the event, the patient had ongoing essential hypertension.  The patient was up-to date with cancer screening, had no recent surgery, prolonged travel or immobilization, past or current cancer, history of blood clots or pregnancy loss.  Past medical treatment(s), vaccination(s) concomitant medication and family history were not provided.  Once health department captured and confirmed that the bat to have rabies then on an unknown date, the patient received a dose of suspect RABIES VACCINE produced by unknown manufacturer (lot number and expiry date were not reported) via unknown route in unknown administration site for post-exposure immunization and a dose of HUMAN ANTIRABIES IMMUNOGLOBULIN (HUMAN RABIES IMMUNOGLOBULIN) produced by unknown manufacturer (lot number and expiry date were not reported) via unknown route in unknown administration site for Animal bite.  On an unknown date the patient developed a serious acute pulmonary embolism/ submassive pulmonary embolism/ bilateral proximal pulmonary embolism (pulmonary embolism) with symptom of pleuritic chest pain (pleuritic pain) few days following the administration of RABIES VACCINE and HUMAN ANTIRABIES IMMUNOGLOBULIN. These events were assessed as medically significant and was hospitalized.  Relevant laboratory test results included:  On an unknown date, the patient was hypoxemic on room air on examination, computerised tomogram of chest with result confirming bilateral proximal pulmonary embolism with an increased right to left ventricular ratio, suggesting right heart strain and echocardiogram with result as normal ejection fraction with mild right ventricular (RV) systolic dysfunction   The patient was treated with HEPARIN (HEPARIN) for pulmonary embolism and discharged two days later.  At time of reporting, the outcome was unknown for the event.  Reporter stated that acute venous thromboembolism following administration of immunoglobulin products had been described but never after a rabies immunoglobulin administration.  Relatedness of events with suspect products was not provided by reporter.  There will be no information available on the batch number for this case.; Sender's Comments: This case concerns 80 year old female patient who experienced pulmonary embolism after vaccination with RABIES VACCINE and HUMAN ANTIRABIES IMMUNOGLOBULIN (produced by unknown manufacturer). The time to onset is unknown. Condition at the time of vaccination was essential hypertension. Additional information regarding patient's past medical history, lab data excluding other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the vaccine cannot be assessed.