Age: 65.0
Sex: F
Vaccine: HEPA, YF
Symptoms: Inappropriate antidiuretic hormone secretion, Lymphocyte percentage decreased, Monocyte percentage, Muscular weakness, Nausea
Clinical narrative: Initial report received on 23 October 2007 from a literature article citation.  The events in this case correspond to VAERS number 96427.  A 63-year-old female patient had received a first dose injection of YF-VAX, lot number not reported, route and site of administration not reported; and a first dose injection of HAVRIX, manufacturer SmithKline Beecham, lot number not reported; on an unspecified day in January 1997.  Sixteen days post-vaccination, the patient began to experience symptoms associated with Guillain Barre syndrome.  The symptoms included headache, numbness and tingling, unstable gait, blood pressure of 240/118, extremity weakness, and decreased deep tendon reflexes.  The event required hospitalization.  CSF YF IgM was not done.  Peak CSF WBC was 0, and peak CSF protein was 40 mg/dl.  Treatment received was not reported.  At the time of hospital discharge, the patient had improved clinically but had mild neurological residual.  Blood pressure returned to near baseline but was more difficult to control than before the illness.  Motor function had returned to near normal.  The diagnosis from the treating physician was Guillain Barre syndrome.  The yellow fever working group case classification was suspect for Guillain Barre syndrome.  A corrective version was created on 29 October 2007 with the LRD of the previous version, (23 October 2007), in order to document the additional information received on the accompanying VAERS report (#96427) which was received from the Centers for Disease Control and Prevention.  Verbatim from the 1997 VAERS narrative (illegible sections will be noted): "A 60-70-year-old woman received a dose of HAVRIX (1440EU IM) in Jan-97.  Yellow fever vaccine is noted as a concomitant vaccination.  One the week-end of 8-Feb-97, she suffered a headache and her blood pressure was "sky high".  She was seen in the ER on 13-Feb-97, diagnosed with Guillain-Barre syndrome, and hospitalized.  (Large illegible area) JVP was 10cm.  Her initial hospital course was marked by some confusion and deterioration in motor strength, as well as pulmonary vital capacity.  She developed an inability to adequately swallow food and was placed on NUTREN 1.5 tube-feedings via naso-gastric tube, which she tolerated well.  The patient was treated with intravenous immunoglobulin and her hospital course was one of eventual improvement.  She had uncomfortable paresthesias which were also treated.  The patient was found to have syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADHS) with normal serum sodium, later dropping to 122.  Please see other lab finding below.  Other medications during hospitalization included acetaminophen 650mg po tid, amitriptyline 20mg po qhs, COLACE po 1/day, PREMARIN 0.625mg po daily, PEPCID 20mg qid, heparin 5,000 sc bid, labetalol 300mg po q6h, KCL 20mEq po tid, (illegible wording), and nitroprusside drip.  The consulting physician felt that her rapidly worsening blood pressure (although she was on a DYAZIDE diuretic) would be consistent with renal artery stenosis.  He found no evidence of ischemic nephropathy in that her creatinine was normal.  His SIADHS was treated with fluid restriction and blood pressures were controlled (initially with IV infusions).  Her hyponatremia and accelerated hypertension ceased to be significant management problems at the time that her neurological recovery began.  She was discharged on 3-Mar-97 in improved condition, still with some significant weakness - to continue with outpatient therapy.  Medications at discharge: amitriptyline 35 mg qhs, RESTORIL 15 mg qhs, PREMARIN 0.625mg/day, COZAAR 50mg/day, atenolol 50mg/day and diet as tolerated.  Final diagnosis: acute Guillain-Barre syndrome, possibly related to hepatitis A vaccination, associated with SIADHS and accelerated hypertension with underlying essential hypertension."  The following additional, not previously noted terms were documented by hand in the margin of the VAERS report: "hypokalemia, pain chest, nausea, eructat, hypokinesia, myasthenia, reflexes dec."  The yellow fever working group classified the event of Guillain Barre syndrome as suspect for a vaccine-associated disease (previously documented as suspect for Guillain Barre syndrome).