We received from a health care professional via the Medical Communication the following information on 16 OCT 2008: A 49-year-old man, born on 26 FEB 1959, was vaccinated with 0.5 ml FLUVIRIN, batch-no. 89881, i.m. on 04 OCT 2008. On 13 OCT 2008 the patient began to experience pain between his shoulders, with pain progressing throughout the body, he developed a low grade fever, and became lethargic and confused. The patient was transported to the emergency room, where he was started on vancomycin, rocephin, and acyclovir for possible meningeal encephalitis. Patient was admitted to the hospital on 14 OCT 2008. On 15 OCT 2008 a lumbar puncture revealed the following: first 4 ml tube showed cerebral spinal fluid clear and colorless, no white blood cells, no red blood cells, and the second tube showed cerebral spinal fluid protein 40 (high), red blood cells 40 (high), protein 86 (high), and glucose 84 (within normal limits). Review of manufacturing protocols demonstrated that there were no deviations affecting product. No change in assessment. We received from the reporting health care professional the following information on 30 OCT 2008: The patient was discharged on 20 OCT 2008. No change in assessment. We received additional information from a physician on 17 NOV 2008: The patient recovered from meningoencephalitis symptoms completely in 5-6 days. Due to HIPAA rules, the physician is unable to send the hospital report. No change in assessment. We received the hospital report on 24 NOV 2008: The patient was admitted after having a flu-like illness for approximately one to two days prior to admission. On presentation to the emergency department, the patient was obtunded with complaint of generalised body aches and neck stiffness. He had a waxing and waning mental sensorium and was therefore admitted for neurological evaluation and monitoring. CNS cultures remained no growth. Viral serologies remained negative. CT scan was performed, which did not show any abnormal enhancing masses, midline shift or intracranial hemorrhages that could explain the patient's presenting symptoms. The EEG showed diffuse semi-rhythmic delta and persistent background slowing consistent with a mild to moderate encephalopathy. There were no epileptiform discharges or patterns noted on his EEG. The patient was continued on antibiotic therapy and steroids and Keppra were added per neurology for concerns for possible seizure. Serologies for West Nile, HIV and HSV were also negative. By hospital day number three, the patient's mental sensorium had improved significantly. He was oriented times three and voiced complaints of headaches, which were treated symptomatically. By the patient's fourth day of hospitalisation, he had returned to his baseline mental status and was ambulating without difficulty. While the patient's labs, imaging and serology testing remained negative, it was felt that his condition was most consistent with a viral encephalitis. There was some concern that presentation could have been post-flu vaccine related as the patient had received a flu vaccination approximately eight days prior to the onset of symptoms. At the time of discharge, the patient was in his usual state of health with baseline mental status. He is discharged home in good condition. Current anxiety and depression, in history testicular cancer and deep venous thrombosis.