Sex: F
Vaccine: COVID19
Symptoms: Toxicity to various agents
Clinical narrative: MULTIPLE DRUG TOXICITY; This spontaneous report was received from literature. The brand was not reported and it is assumed to be the J&J brand for reporting purposes This report concerned a 52 year old female. Introduction: This is the Annual Report. As of 1 January, 2022, all 55 of the nation's poison centers uploaded case data automatically to database.  Methods: We analyzed the case data tabulating specific indices from the Data System. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality of the exposure. Results: In 2022, 2,483,183 closed encounters were logged by the Data System: 2,064,875 human exposures, 50,381 animal exposures, 363,099 information requests, 4,790 human confirmed nonexposures, and 38 animal confirmed nonexposures. The upload interval was 4.72 [4.40,9.27] (median [25%, 75%]) minutes, effectuating a near real-time national exposure and information database and surveillance system. Total encounters showed a 12.9% decrease from 2021, and human exposure cases decreased by 0.771%, while health care facility human exposure cases increased by 0.214%. All information requests decreased by 48.4%, medication identification (Drug ID) requests decreased by 21.2%, and medical information requests showed a 76.92% decrease, although these remain twice the median number before the COVID-19 pandemic. Drug Information requests showed a 52.4% decrease, due to declining COVID-19 vaccine calls to poison centers but still comprised 5.55% of all information contacts. Human exposures with less serious outcomes have decreased 1.70% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased 4.41% per year since 2000. Consistent with the previous year, the top 4 substance classes most frequently involved in all human exposures were analgesics (11.5%), household cleaning substances (7.23%), antidepressants (5.61%), and cosmetics/personal care products (5.23%). Antihistamines (4.81%) replaced sedatives/hypnotics/ antipsychotics as the 5th substance class. As a class, analgesic exposures increased most rapidly, by 1,514 cases/year (3.26%/year) over the past 10 years for cases with more serious outcomes. The top 5 most common exposures in children age 5 years or less were household cleaning substances (10.3%), analgesics (9.54%), cosmetics/personal care products (9.49%), dietary supplements/herbals/homeopathic (6.65%), and foreign bodies/toys/miscellaneous (6.61%). The Data System documented 3,255 human exposures resulting in death; 2,622 (80.6%) of these were judged as related (Relative Contribution to Fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). Conclusions: These data support the continued value of poison center expertise and the need for specialized medical toxicology information to manage the increasing number of more serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the specific country. The near real-time status of the Data System represents a national public health resource to collect and monitor exposure cases and information requests. The continuing mission of the Data System is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. The Data System is a model system for the near real-time surveillance of national and global public health. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (Dose in series 1) (suspension for injection, unknown, batch number was not reported) dose, start therapy date were not reported for covid-19 prophylaxis. Non-company suspect drugs included: paracetamol ( form of admin, route of admin, and batch number were not reported) dose, frequency, and therapy dates were not reported for an unspecified indication. ; ethanol ( form of admin, route of admin, and batch number were not reported) dose, frequency, and therapy dates were not reported for an unspecified indication. ; and silybum marianum ( form of admin, route of admin, and batch number were not reported) dose, frequency, and therapy dates were not reported for an unspecified indication. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced drug toxicity (Dose in series 1), and was hospitalized (date unspecified). On an unspecified date, the patient died from multiple drug toxicity. It was unknown if an autopsy was performed. It was reported that along with SARS-COV-2 covid-19 vaccine, acetminophen, ethanol (beverage) and silymarin was found as nonpharmaceutical and pharmaceutical exposures in patient's blood. The substance rank and cause rank for acetminophen, ethanol (beverage), SARS-COV-2, covid-19 vaccine and silymarin was reported as 1, 2, 3, and 4 respectively.  It was reported that the RCF (Relative Contribution to Fatality) was 2. The route was reported as ingestion, however the chronicity and reason for ingestion were both unknown. In the opinion of the Case Review Team the Clinical Case Evidence suggested that the substances caused the death, but some reasonable doubt remained. The action taken with covid-19 vaccine ad26.cov2.s was not applicable; and action taken with paracetamol, ethanol, and silybum marianum was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender's Comments: V0: Toxicity to various agents. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). Therefore, this event(s) is considered unassessable.; Reported Cause(s) of Death: MULTIPLE DRUG TOXICITY