Sex: F
Vaccine: MEN
Symptoms: Coma scale normal, Cortisol increased, Fall, Hepatomegaly, Hyperhidrosis
Clinical narrative: Initial information received a literature article on 17-Jan-2019. This case involves a 16 years old female patient who experienced syncope, altered mental status, anuric, tachycardic, hypotension, chest pain, diaphoresis, nausea, vomited, became clammy, fell to the ground unresponsive, remained groggy and small right pleural effusion, while she received vaccine MENINGOCOCCAL VACCINE. The patient's past medical history included Pericardial drainage, cardiac catheterization and Biopsy. The patient's past medical treatment(s), vaccination(s), family history and concomitant medication were not provided. Notes: She reported a similar episode during final exams during her previous school semester that was attributed to stress after a reassuring evaluation. She was started on an antidepressant medication, which she discontinued taking 3 weeks ago due to improvement in symptoms. On an unknown date, the patient received a dose of suspect MENINGOCOCCAL VACCINE produced by unknown manufacturer lot number not reported via unknown route in unknown administration site. On an unknown date, the patient developed a serious syncope, altered mental status, anuric following the administration of MENINGOCOCCAL VACCINE. These events were assessed as medically significant (IME). On an unknown date, the patient developed a serious tachycardic and hypotension following the administration of MENINGOCOCCAL VACCINE. The patient was hospitalized for this event. On an unknown date, the patient developed a non-serious chest pain, diaphoresis, nausea, vomited, became clammy, fell to the ground unresponsive, remained groggy, small right pleural effusion following the administration of MENINGOCOCCAL VACCINE. Relevant laboratory test results included: Blood cortisol - On an unknown date: 49 mg/dL, Blood glucose - On an unknown date: 187 mg/dL, Blood lactic acid - On an unknown date: 40.5 mg/dL, Body temperature - On an unknown date: 36.4 Cel, Carbon dioxide - On an unknown date: 38 mmol/L, Hepatomegaly - On an unknown date: 4 cm [below the costal margin], Metabolic acidosis - On an unknown date: 7.29 pH, Troponin I - On an unknown date: 0.04 ng/mL, White blood cell count - On an unknown date: 28.8 10*9/L. (Other relevant tests included heart rate, 120 beats/min; respiratory rate, 23 breaths/min; blood pressure, 95/44 mm Hg; and oxygen saturation, 98% on room air. On physical examination, she is sleepy but responsive, with a Glasgow Coma Scale score of 15, delayed capillary refill, 2þ pulses, brain-type natriuretic; peptide level, 42 pg/mL (42 ng/L); Chest radiography shows diffuse nodular opacities throughout both lungs.. An electrocardiogram is performed that shows right axis deviation and pericardial inflammation.) Final diagnosis was small right pleural effusion, remained groggy, fell to the ground unresponsive, became clammy, vomited, nausea, diaphoresis, chest pain, hypotension, tachycardic, anuric, altered mental status and syncope. The patient was treated with Epinephrine, Diphenhydramine, Methylprednisolone, Famotidine and Paclitaxel. Outcome of the events was not reported. List of documents held by sender: none. Sender's Comments: Patient presented with right pleural effusion, grogginess, fall, clamminess, vomiting, nausea, diaphoresis, chest pain, hypotension, tachycardia, anuria, altered mental status and syncope after vaccination. Time to onset is unknown. Patient has a history of cardiac catheterization and pericardiocentesis. Moreover, further information including patient's concomitant medications, previous vaccination and tolerance, laboratory investigations excluding other etiology would be needed to fully assess this case. Based on available information, the role of vaccine cannot be assessed.