Age: 63.0
Sex: M
Vaccine: YF, YF, HEP, HEPA, TYP
Symptoms: Anorexia, Back pain, Blood bilirubin increased, Chills, Delirium
Clinical narrative: From initial information received on 2/9/04 through an enhanced surveillance program conducted by the Centers for Disease Control and Prevention regarding an adverse event occurring in the USA, it was reported that a 63 year old male patient (date of birth not reported) received a dose of YF-VAX (lot number, route and site of administration not reported) on 1/29/04. On 2/4/04, the patient was hospitalized with symptoms of fever of 102.4 degrees F, jaundice, belly pain and chest pain. The date of the onset of symptoms was not reported. On 2/7/04, the patient left the hospital. The patient's recovery status was not reported. From additional information received on 13FEB2004 from the Centers for Disease Control and Prevention, it was reported that the CDC received one sample of serum that had been collected from the patient on 04FEB2004, according to information that accompanied the sample. TaqMan RTPCR tests were performed and results were positive for YF I7-D. Given the specifice of the testing results (count values), the doctor did not feel that he was likely to get any isolata from attempted culture of this specimen, no standart RT-PCR was performed as a special investigation to try and amplify a fragment for sequencing, which was not successful. The sample volume was also quite small. No other testing is pending since there is no more sample available. No other information was provided at this time. From additional information received on 20/FEB/2004 from the Centers for Disease Control and Prevention, it was reported that the patient had no detachable IgM or IgG antibodies against yellow fever. No other informatioin was provided at this time.  Additonal information was received on 04Mar20004 from the CDC from the minutes of the yellow fever meeting on 09Feb2004. It was reported that the patinet received Typhoid Vaccine, Hepatitis A vaccine and Hepatitis B vaccine on 28JAN2004, one day prior to receiving YFVAX. Patient had experienced a head cold and a cough for about two weeks prior to the YF vaccine. On 02FEB2004, the patient had vomiting, cills, fever, dizziness, hemoptysis, low back  pain, headache and possible delirium. On 03FEB2004, he began to develop jaundice. He lost his appetite and lost about nine pounds in about four days. He went to the emergency room on 04FEB2004 and was hospitalized for four days. A sputum culture was positive for strep penumonia. He had a macular papular rash on the right side of his back. The admitting diagnosis was strep pneumonia and yello fever vaccine reaction. The treating resident did not think the strep pneumonia was the cause of the patient's jaundice and the liver problem. Additional information received 18MAR2004: The merck case number was provided as WAES0403USA01249. No other information was provided. From additional information received on 23APR2004, the results of laboratory testing performed during the patient's hospital stay. See the laboratory comment section in box 12 of the VAERS form for details. The patient's date of birth was also provided. No other information was reported at this time. From additional information received on 5/6/04 from the CDC, it was reported the serum sample collected on 2/24/04 is negative for PCR for YF 17D RNA, is YF IgM positive on ELISA and P/N is 14.6. IGG Elisa is negative. P/N is 1.6. AE coding was updated to include strep pneumonia.