Exploratory data analysis. Excerpt from the VAERS database.
Vax_type: single flu4 shot
Suicide, Self inflicted gunshot wound
Patient first evaluated by Clinic 3/2018. Reports in January 2018 reported some low back pain after working with a snow blower. A few weeks after this, noted some rectal and bladder burning and ‘urgency’ – lasted 4-5 days and then resolved.
Toward the end of Jan, flew to and back and had trouble getting out the airplane seat. In February 2018 went snowshoeing and fell, noted legs aching. Noted decreased power in the quads bilaterally and this progressed to a feeling ‘like my legs are disconnected from me, like my quads are weak.’
Early March 2018, symptoms progressed and more noticeable. Felt like knees might give out when getting up and down. Went to the ED – had cardiac/syncope r/o on telemetry. Didn’t mention his lower extremity concerns during that visit. Symptoms continued.
In April, patient reported legs “feeling buzzy”, some numbness in upper extremities, particularly bilat pinky fingers, pins and needles from biceps to tips of fingers. Towards end of April, some abdominal pain reported, intermittently, decreased appetite. Some SOB (Shortness Of Breath), had panic attack, situational anxiety.
Patient seen again in May, continued progression of paresthesias in upper extremities. Reports having “fogginess” worse in AM, feeling jittery, sometimes has the sense that “brain is on fire.” Reported feeling anxious, ongoing. Frontal HA and neck pain reported. Situational anxiety ongoing. Passive suicidal thoughts with no plan or intent.
End of May reported arms and legs feeling worse, losing strength despite exercise; unintended weight loss, GI cramps; twitching in arms, legs, hands, L>R; headaches; mild cognitive foggy feeling; anxiety.
Seen by office in early June, reported legs still feeling numb and “on fire”, but overall better; HA and neck pain.
Late June reported feeling jittery, anxious, with sense of doom. Again reported passive suicidality with no plan or intent; continued weight loss, bowel movements every 3-4 days with abdominal cramping, nausea. Discussed seeing a psychiatrist for ongoing anxiety.
Seen multiple times between March and July with ongoing symptoms; saw several specialists for workup during this time. Most recently seen by our office 7/2/2018, plan to return to work discussed. Ongoing HAs, constipation, situational anxiety.
Called office 7/9 feeling jittery and with mental fogginess and forgetfulness, SOB with exercise. Plan to see gastroenterology 7/10 for further testing.
7/10/18 self inflicted gunshot wound, patient deceased.
*3/10/18 MRI brain, cervical, thoracic, and lumbar spine Brain: symmetric bilateral periventricular signal hyperintensity as well as seen in a pericallosal distribution suggestive of a demyelinating process. This might be confirmed with evaluation of CSF. Vascular structures as covered demonstrate a normal flow void. Spine: foraminal narrowing at C4, C5 but no cord signal abnormality or suggestion of cervical stenosis.
Of note on T spine was predominantly erythropoietic red marrow suggestive of anemia and 1.3cm hyperintense cyst R kidney *3/17/18 MRI brain, cervical and thoracic spine: Brain: small focal and more patchy regions of T2 and T2 FLAIR signal hyperintensity within the supratentorial periventricular, centrum semiovale, and to lesser extent subcortical white matter appear entirely unchanged when compared to the 3/10/2018 exam.
Although the possibility of a demyelinating process was raised on the report from the previous brain MRI and that such process cannot with certainty be excluded, I favor that these represent sequela of chronic microvascular ischemic change.
*3/17/18 CT CAP: negative except fatty liver *3/19/18 EEG: negative *3/14/18 EMG: negative CBC: WBC count 3.2 on 3/18/18; (WBC count 3.6 on 3/17; 6.5 on 3/6). Otherwise normal CMP: 3/17/18: Total protein 8.5, alb 3.7, globulin 4.8 CRP: normal 1.0 CK normal (298) TSH: normal Vit B12: normal Vit B1: normal Vit D: low normal at 26.6 Folate normal Mg normal Hgb A1c normal at 5.6 heavy metals panel negative HIV negative lyme negative, anaplasma negative,
ehrlichia negative EBV negative varicella zoster ab Ig positive (immune) treponemia pallidum Ab IgG + RPR negative Syphilis ab TP-PA indeterminate tissue transglutaminase negative complement C3,C4 normal thyroglobulin Ab negative thyroid peroxidase Ab 422.9 (<100) ANA negative Sjogrens Ab negative ACE negative Paraneoplastic auto antibody eval negative P-ANCA, C-ANCA negative Antiphospholipid Ab negative AntiMog Ab negative NMO/AQP4 FAC serum negative Ganglioside Ab panel negative CSF: 3/9/18: protein 101 (15-45); glucose 67, cell counts normal.
MS panel elevated albumin but normal ratios. 3/19/18: protein 98, glucose 59, cell counts normal flow cytometry negative for lymphoma VZV PCR; Varicella zoster Ab IgG, IgM – negative HSV negative CSF gram stain negative. EGD 5/18/18, MRI brain and c-spine 5/17/18. EMG 4/27/18
Use vaers_2018; go Select vaers_id , sex , age_yrs , died , symptom_text , lab_data from dbo.[2018vaersdata] where vaers_id = 761392; go Select * from dbo.[2018vaersvax] where vaers_id = 761392; go Select * from dbo.[2018vaerssymptoms] where vaers_id = 761392; go
Or, open the files, 2018vaersdata.csv, 2018vaersvax.csv, 2018vaerssymptoms.csv, into a spreadsheet, and search for the VAERS_ID.
Reported by the patient’s physician.
Looking at 2018vaerssymptoms, there are 81 “symptoms” listed. The most for a single VAERS_ID in 2018.
Many of the “symptoms” are in fact the results of many tests. ie. C-reactive protein normal. Vitamin B12 normal.
The physician has entered as much information as possible into the database.
The physician seems to have been very disturbed by the suicide of the patient that (s)he was unable to prevent.