Age: 34.0
Sex: M
Vaccine: HEPAB, YF
Symptoms: Arthralgia, Cough, Erythema, Hypokinesia, Joint swelling
Clinical narrative: From initial information received on 16Sep04 from another manf (ref report number A0524877A) regarding an adverse event occurring, it was initially reported by a RN that a 33 yr old male pt received a dose of YF vax, lot number and site of admin unk as well as a second dose of Twinrix, lot HAB015A8, admin in the right arm on 20Aug04. The routes of admin were not reported for either product. Fourteen days later, on 03Sep04, the pt developed swollen joints and joint pain in his hands and feet. The pt was hospitalized. The events were ongoing at the time of this report and the pt had not recovered. The nurse considered the events to possibly be related to vaccination with Twinrix. From additional information received on 19Nov04 it was reported that the pt received the YF vax and Twinrix vaccinations in preparation for travel for work. On 03Sep04, the pt also experienced pain in his hands and feet as well as swollen, painful joints. His diagnosis was probably serum sickness and he was treated with steroids. He was admitted to the hospital on 03Sep04 and discharged two days later on 05Sep04. The pt's recovery status was not provided. From additional information received on 29Nov04 it was reported that the pt was undergoing an accelerated hep immunization schedule and received a first dose of HAV/HBV (Twinrix) vaccine three weeks prior to admission. He received a second dose of HAV/HBV (Twinrix) vaccine on 20Aug04, as well as a first dose of YF vax. He was scheduled to receive the third dose of Twinrix on the date on 03Sep04, but awoke that morning with hand and foot pain and swelling with limited range of motion. His hand pain was seven out of ten and was worse than the foot pain. He had no rash, fevers, or chills. He took ibuprofen, which made his hands and feet feel better. At work, the pt saw a nurse who recommended that he go to the hospital. In the hospital emergency room, he was treated with 125 milligrams of SoluMedrol and ibuprofen, which improved his symptoms. His medications at the time of admission included Zithromax, Robitussin and Tylenol sinus for pharyngitis, sinus congestion and an occasional cough. He had taken two doses of the Zithromax by the time he went to the hospital. Physical examination at the hospital revealed mild erythema of the posterior pharynx without any exudates or edema. He had some decreased range of motion in his hands with swelling. No obvious effusions were palpable. There was no erythema, areas of warmth or significant tenderness.  His feet revealed trace edema over the ankles, which was much more pronounced over the wrists and hands. He was diagnosed with probable serum sickness as a result of the hep AB accelerated combination. While hospitalized, he continued received 40 milligrams of SoluMedrol, every eight hours, along with Benadryl and ibuprofen. The pt was very stable during hospitalization and anxious to go home by 04Sep04. The joint swelling had decreased by 05Sep04 and the pt was subsequently discharged home the same day with a steroid taper. It was reported that during a telephone call with the pt on 27Oct04, he reported that he had fully recovered from these events. From additional information received on 23Dec04 from a RN a correction was made to the spelling of the reporter's last name. It was reported that the pt received his first dose of YF Vax, lot UE265AA, admin SC in the left deltoid as well as his second dose of Twinrix, admin IM in the right deltoid. It was also reported that the pt recovered from the events. From additional information received on 25Feb05 from a RN, it was reported that the pt received Twinrix, lot number AHABA015AA, admin IM in the right deltoid on 13Aug04 and 20Aug04. Reportedly, the symptoms started on 03Sep04 and ended on 10Sep04. By then, the pt had fully recovered. Per the reporter, lab data and the discharge summary are not available. No further information is anticipated, this case is considered closed. Relevant test/lab data: UNK. Follow up: 19Nov04: Specimens were available for testing at the pt refused to give a convalescent serum sample the CDC. Follow up 29Nov04: Vital signs: T98.6 degrees F, pulse 66, respiratory rate 16, blood pressure 135/67. Admission Labs 03Sep04: WBC 11 differential normal; Hgb 15.1; HCT 44.2; PLT 251; Na 142; Cl 106; BUN 13; Glu 89; K 4.2; CO2 27; CR 1.2; Alkaline phosphatase 83; ALT 44; AST 23; T Bili 1.8; Albumin 4.5; INR 1.1; ESR 10. Other labs (04Sep04): ESR 21; ANA Negative; C3 143; C4 33; IgA 287; IgG 963; IgM 56; RF 8.