Age: 24.0
Sex: M
Vaccine: ANTH, YF
Symptoms: Oedema, Pain, Pyrexia, Scrotal oedema, Sleep disorder
Clinical narrative: Information has been received from a health professional, through a surveillance program conducted by an agency concerning a 24 year old male who on 3/23/03 was vaccinated with a dose of measles virus live (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (manufacturer unknown) (batch # not reported). Other suspect therapy included tuberculin purified protein derivative given on 3/23/03, a first, second and third dose of anthrax vaccine absorbed given on 3/23/03 (in left arm, batch # FAV074), 4/6/03 and 4/20/03 respectively and a dose of yellow fever virus vaccine (batch # UB254AA) given on 4/20/03. On 5/28/03 the patient developed severe testicle pain, testicular swelling and migraines. In October 2003, the patient had a seizure, which the doctor's believed to be due to an epididymitis, a severe infection of the testicle. The patient was hospitalized for three days. Due to the approximately five month time-frame between vaccination and the seizure/hospitalization, a cerebrospinal fluid sample test was not requested by the agency. It was reported that the patient was treated with several courses of antibiotics, but the testicular swelling and pain persist. The patient was also treated for two days with phenytoin for his seizure. The seizure has not recurred. It was also reported that, on an unspecified date the patient developed a sleeping disorder. His relevant diagnostic testing at that time included a CAT scan, EEG, ultrasound, and spinal tap. The patient had not recovered at that time. He current recovery status was not reported. It was noted that the patient did not receive any further anthrax vaccines. Medical records have been requested by the agency. No further information was provided at this time. Follow up information from an agency noted the patient smokes (how many packs per day was unknown) and has allergies to doxycycline, PCN and had a history of right inguinal herniorrhaphy (traumatic hernia) in May 2002 and a gunshot wound to the right chest (no sequelae) in July 2002. Information received also noted that the patient had no significant past medical history and was in an unusual state of health until approximately two months following a yellow fever virus vaccine (YF-VAX) vaccination when he developed testicular swelling and pain. He was diagnosed with epidiymitis by a medical doctor and treated with several courses of antibiotics (brands not specified) without resolution. On 15-Oct-2003 the patient developed severe incapacitating headaches. On the afternoon of 18-Oct-2003, while sitting on the floor and playing a video game, the patient experienced a grand mal seizure for five minuts. The seizure was witnesses by his wife. The patient had no previous history of seizures. The patient was transported to the hospital, where the admitting diagnosis was gran mal epilepsy. On presentation to the emergency department on 18-Oct-2003, the patient had a temperature of 99.1 degrees Fahrenheit, but otherwise normal vital signs. The patient was dosed with phenytoin (Dilatin) 300 mg po and admitted. Laboratory evaluation on admission revealed: Utox negative; urinalysis negative; CSF: clear, colorless, RBC 1000, WBC 0, Protein 36, glucose 60, gram stain negative, no growth of bacteria/fungi times four days; WBC 14.7 (N65.4/L27.5); H/H 14.8/43.6; platelets 326; Cr 1.2; electrolytes wnl; total bili 06; ALT 35 and AST 23. He was placed on bed rest and started on phenytoin (Dilatin) 100 mg po tid as well as acetaminophen (+) butalbital (+) caffeine (Fioricet) 1 tab every 6 prn for headache. At rounds in the am of 19-Oct-2003 the patient was given acetaminophen (+) hydrocodone bitartrate (Lortab) 7.5 one tab every 6 hours for pain, ceftriaxone sodium (Rocephin) 1 g q12h IV and azithromycin (Zithromax) dosepak were started. Patient was seizure free until the am of 20-Oct-2003 when questionable seizure activity was witnessed for less thatn 45 seconds (without fecal/urinary incontinence). No dizziness, confusion or neurolgical deficits were noted. All vital signs were stable. Hospital studies included CT scan without contrast which was normal and an EEG which was normal. In the afternoon of 20-Oct-2003, the patient requested discharge. Ad the patient was symptom free he was discharged on axithromycin (Zithromax) dosepak and prn pain meds. His discharge diagnosis was grand mal seizure, isolated and headaches. Reportedly the first onset to symptoms began approximately two months following the yellow fever vaccination and the second symptoms began seven months after vaccination (previously reported as epidymitis, testicle pain, migraines, testicular swelling and a sleep disorder on 28-May-2003 and seizure in October 2003). No further information was provided at this time. Other business partner numbers include: 2003-03321 and 212904.