Age: 30.0
Sex: M
Vaccine: FLU(H1N1)
Symptoms: Arthralgia, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal, Bronchospasm, Cardiac enzymes normal
Clinical narrative: 32 yo M received H1N1 vaccine late in the afternoon on 13 November 2009. No other concomitant vaccines were administered that day. That evening, SM experienced achy joints, fever, night sweats (linens wet), and nausea. Over the next 24 hours, he experienced 2 episodes of vomiting. He denies any hives/rashes, flushing, itching, lip/tongue swelling, nasal symptoms, throat tightness, or difficulty swallowing. On 14 November (post-vaccine day 1), SM's fever continued and he experienced a dry cough. By 15 November (post-vaccine day 3), the cough progressed to a vigorous, productive cough accompanied by wheezing. SM was coughing so hard and so often that his ribs hurt and his chest muscles were sore. This continued for another 48-72 hours before he was evaluated in the ER on 18 Nov. Patient sought evaluation because, in addition to his cough, he also experienced chest discomfort - "heart hurt". Described chest pain sensation "like a bruise". He denies significant shortness of breath, but recalls only being able to take shallow breaths due to pain. When he coughed, chest discomfort increased in intensity to a 10/10 using pain scale of 0 (=no pain) to 10 (= worst pain ever experienced). He denies increase in pain when lying flat or pain decreasing when leaning forward, but does describe substernal sensation of his heart "straining...feels like a muscle being stretched", but only when lying or leaning to the left side. He denies palpitations. ER evaluation on 18 November noted fever, aches, malaise, dizzy, nausea and nonproductive cough. VS: Temp 100.8, BP 159/103, P 107, R 18, SaO2 98. Diagnosis was influenza, post-infectious; bronchospasm. He was treated with TAMIFLU 75 mg 2x/day for 10 days. No labs or ECG visible from that visit. SM recalls over the next week, his sore chest muscles and ribs gradually improved, but he continued to experience wheezing, persistent cough and "heart" discomfort. Discomfort was intermittent and varied in intensity. In Int Med on 25 Nov, he sought evaluation for CC: "chest discomfort". An EKG was done; electronic copy with computerized interpretation: NSR, left atrial abnormality, nonspecific ST wave changes. Patient also had CXR which was unremarkable. He was prescribed Guaifenesin and BP medication (Lisinopril) and instructed to continue albuterol and MOTRIN. On 1 Dec 2009, SM had negative cardiac enzymes x 1 with no associated clinical note visible. No additional follow-up related to chest discomfort or abnormal ECG visible. By mid-December 2009, SM recalls all symptoms resolved except for "straining" sensation of heart when lying on left side, which continues at present. Patient reported feeling well day of and prior to vaccination receipt in Nov 2009. No prior vaccine reactions. There is a record of receipt of seasonal flu vaccine on 9 Sep 2009. Since 2009, pt has not received any seasonal influenza vaccines which have contained H1N1 component since 2010, but did receive SPV, anthrax, and typhoid vaccine in Aug 2010 without adverse events. SM denies allergic reactions to drugs, foods, latex, and insect stings. He does not recall known exposures at that time, but he was working in the ICU. He was not taking any routine medications at the time of vaccine receipt.