Age: 56.0
Sex: M
Vaccine: TYP, TYP
Symptoms: Abnormal behaviour, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood urea nitrogen/creatinine ratio, Brucella test negative
Clinical narrative: Case number PHHY2015US100319, is an initial spontaneous report from the Vaccine Adverse Event Reporting System (VAERS, reference number: 574621) website on 11 Aug 2015. This report refers to a 56 years old male patient. The patient had no known drug allergies. Medical history included hemorrhoids, neutropenia (evaluation in 2008-2009 was normal), sciatica, shortness of breath and difficulty swallowing. Concurrent conditions included hypercholesterolemia, itchy ears due to food allergies (shellfish) and environmental allergies (possible spring molds otherwise none). Family history included heart disease, mental illness; sister had cancer (leukemia?). Concomitant medications were none. His vaccination history included intramuscular administration of typhoid vaccine (manufacturer and batch number: unknown) during his 23 years career without any reactions. The patient was vaccinated with booster dose of meningococcal vaccine (manufacturer and batch  number unknown) and booster dose of yellow fever vaccine (manufacturer and batch number unknown) on 10 Mar 2015. The patient was vaccinated with first dose of VIVOTIF (batch number: 3000844, other manufacturer) via oral on 11 Mar 2015. Further the patient was vaccinated with second and third dose of VIVOTIF (batch number: unknown) on 15 Mar 2015. On the same day (15 Mar 2015), after vaccinations, the patient experienced runny nose, nasal congestion and fever which worsened further. The patient presented to primary care physician (PCP) with complains of persistent fever ranging 101 - 103.1 Fahrenheit (F), chills, night sweats, generalized malaise, upper respiratory infection (URI) like symptoms (runny nose, congestion, postnasal drip, non-productive cough), body aches and episodic headaches (diffuse-facial). Further the patient complained that his urine was tea colored with first void but cleared for 4 liters water/Gatorade during the day. The patient's wife reported that the patient did not seem himself and was not "thinking clearly" as he did prior to his vaccinations. On 20 Mar 2015 the patient continued alternating MOTRIN and TYLENOL for persistent recurrent fevers which would go down to 100 Fahrenheit. Laboratory tests performed on 20 Mar 2015 included mild elevation of aspartate aminotransferase (53, units not reported), mild elevation of alanine aminotransferase (54, units not reported), low blood urea nitrogen/creatinine (7/1.1, units not reported), platelet counts were normal (189, units not reported), red blood cell count was low (3.95, units not reported), haemoglobin/haematocrit was low (12.4/35.3, units not reported). MCV, MCH and RDW were all normal. CBC's compared pre and post vaccinations were not significantly different. Chest X-ray was normal. Nasal swab for influenza was negative. Viral lab studies for enterovirus, EBV, CMV and HSV studies were all negative (IgM) with positive CMV, EBV IgG antibodies. Test results for RMSF IgM/IgG and R. Typhi IgM/IgG were not detected. Brucella IgM/IgG antibodies were negative. The patient tested positive for salmonella. Laboratory values also indicated dehydration. The patient was unable to work and was on sick leave greater than 24 hours. The patient stated that his fevers were 99 degree F between MOTRIN doses. The patient uses NYQUIL at night. The patient had stopped TYLENOL and decongestants because it makes his mucus taste bad. No antibiotic therapy was initiated with normal WBC and he did not take the final dose of oral typhoid. The patient was eating well but had a queasy stomach at times due to post nasal drip, his night sweats were less and no headaches (last headache was 22 Mar 2015). On 24 Mar 2015 his body temperature was stable at 98-99 F and he stopped use of MOTRIN. However, his body temperature elevated to 101 F and he restarted use of his MOTRIN. The patient still had nasal congestion and post nasal drip with a mild cough, otherwise he is doing fine. The patient advised his wife now has a cold. The patient was scheduled to see infectious disease provider on 26 Mar 2015. On 31 Mar 2015 the patient no longer had a fever or temperature however he continued with a mild cough. It was stated that he did return to work. Final outcome of the events was recovered. Case was assessed as non-serious. Causality of the events was not reported. Seriousness assessment of upper respiratory tract infection was upgraded based on information in the source document.