Age: 70.0
Sex: M
Vaccine: FLUX, FLUX
Symptoms: Angiotensin converting enzyme, Anterior chamber fibrin, Anterior chamber inflammation, Antinuclear antibody, Antinuclear antibody positive
Clinical narrative: Case number PHHY2015US076614 is an initial spontaneous report received via Vaccine Adverse Events Reporting System (the source of the case in VAERS is a literature publication, VAERS reference number: 577929) on 15 Jun 2015. This report refers to a 70 year old male patient. His medical history included bilateral pseudophakia and a four vessel coronary artery bypass graft operation on an unknown date. His current conditions were well-controlled diabetes mellitus, hypertension, coronary artery disease, non-proliferative diabetic retinopathy with macular edema. His visual acuity prior vaccination was 20/50 in right eye and 20/60 in left eye (six months prior). He was vaccinated with seasonal influenza vaccine (manufacturer and batch number: not reported) on an unknown date for the first time. The day after vaccination, the patient began to develop symptoms and presented to the emergency department with a chief complaint of sudden onset of decreased vision in both eyes which worsened throughout the day. Upon wakening during the night, he noted further worsening in his vision and a dull ache behind the eyes. He denied floaters and photopsias. On ophthalmologic examination, the patient's best-corrected visual acuity was "hand motions" in both eyes. Intraocular pressures were elevated at 28 mmHg in the right eye and 38mmHg in the left eye. Pupils were minimally reactive to light in both eyes, with no afferent pupillary defect in both eyes. Slit-lamp examination showed severe conjunctival injection, diffuse corneal keratic precipitates, nearly 306 degrees of posterior synechiae, and 4+ anterior chamber cells and flare within 1-mm hypopyon in both eyes. B-scan ultrasonography showed vitreous debris without retinal detachment, vitreous haemorrhage or masses in both eyes. Visual acuity was 20/300. Laboratory work-up for uveitis was positive for C-reactive protein (2.1 mg/dL), erythrocyte sedimentation rate (32 mm/hour) and mildly positive antinuclear antibodies (1:80) in a speckled pattern and it was considered nonspecific. Chest x-ray, angiotensin-converting enzyme, rapid plasma reagin, Treponema pallidum microhemagglutination test, rheumatoid factor and extractable nuclear antibody study were within normal limits. Lyme titers, HLA-B27, purified protein derivative skin testing and blood cultures were negative. Treatment included topical steroids (prednisolone acetate 1%) every hour while awake and Scopolamine 0.25% twice daily on both eyes. At the 1-day follow-up visit, the patient stated that his vision had improved and ocular discomfort had subsided. On examination, visual acuity was "counting fingers" in both eyes, improved from "hand motions" the day before. The number of corneal keratic precipitates had decreased, the anterior chamber inflammation had diminished in both eyes and a fibrin clot was developing in the anterior chamber in both eyes. By the following day, the fibrin clot had decreased in size in the right eye and   [Due to memory limitations, the remainder of this text could not be compared.]  t eye and had resolved completely in the left eye. After a short 5-day course of oral steroids and a posterior sub-Tenon's injection of triamcinolone acetate in the right eye, the patient's visual acuity returned to baseline (20/50 in the right eye and 20/60 in the left eye) 3 months after initial presentation. The outcome of the events was reported as recovering. The seriousness of the events was not reported, but the event uveitis was upgraded as medically significant based on the information available in the source documents. The reporter stated that the inflammation was an ocular reaction to the influenza vaccine administered 1 day before the onset of symptoms and that the case demonstrates that on rare occasions, a fulminant immune response might manifest as a bilateral panuveitis.