Sex: F
Vaccine: TDAP
Symptoms: Bordetella test positive, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Cough, Ecchymosis
Clinical narrative: This case was reported in a literature article and described the occurrence of vaccination failure in a 66-year-old female patient who received dTpa vaccine. On an unknown date, the patient received dTpa vaccine at an unknown dose. On an unknown date, 8 years after receiving dTpa vaccine, the patient experienced vaccination failure (serious criteria hospitalization and GSK medically significant), pertussis (serious criteria hospitalization and GSK medically significant), dry cough (serious criteria hospitalization), flank pain (serious criteria hospitalization), ecchymosis (serious criteria hospitalization), tenderness (serious criteria hospitalization), rib fracture (serious criteria hospitalization) and hernia (serious criteria hospitalization). The patient was treated with azithromycin. On an unknown date, the outcome of the vaccination failure, pertussis, dry cough, flank pain, ecchymosis, tenderness, rib fracture and hernia were recovered/resolved. The reporter considered the vaccination failure, pertussis, dry cough, flank pain, ecchymosis, tenderness, rib fracture and hernia to be related to dTpa vaccine. Additional information was provided. This case was reported in a literature and described the occurrence of suspected vaccination failure in a 66-year-old female who was vaccinated with unspecified TdaP vaccine (manufacturer unknown). No information on patient's medical or family history or concurrent condition or concomitant condition was provided. On an unspecified date, the patient received TdaP vaccine (administration route and site unspecified, dosage unknown; batch number). The age of vaccination was not provided. On an unspecified date at the age of 66 years, 8 year after vaccination, the patient presented to her primary care physician's office with a 2-week history of dry cough and severe pain in the right flank. 5 days before presentation, the patient had received a diagnosis of viral upper respiratory tract infection, but her symptoms had not abated with supportive treatment. Physical examination revealed a large ecchymosis across her right flank and tenderness on palpation over the chest wall on the right side. Computed tomography of the chest and abdomen revealed a displaced fracture of the lateral aspect of the 9th rib on the right side. Nasopharyngeal culture confirmed infection with Bordetella pertussis. The patient reported no trauma, had no known sick contacts. Pertussis was associated with paroxysms of coughing, which when severe can lead to complications such as rib fractures and injuries to intercostal vessels. This case has been considered as suspected vaccination failure being time to onset and full schedule was unknown. This case has been considered serious due to hospitalisation/suspected vaccination failure. The patient was treated with azithromycin and underwent surgical repair of the fractured rib and an associated hernia in the chest wall. The patient had a full recovery. Post-exposure prophylaxis with azithromycin was given to household contacts as well as to several members of the clinic staff who had come into close contact with the patient. The authors did not comment on causal relationship between event of pertussis infection and unspecified TdaP vaccine. The authors stated "Pertussis was associated with paroxysms of coughing, which when severe can lead to complications such as rib fractures and injuries to intercostal vessels".