Another Unaccounted Expense of the Flu Vaccine

Editor’s Note: This article is a reprint. It was originally published February 9, 2019.

Any time you undergo a medical procedure, including vaccination, there is a risk of side effects, ranging from mild to severe. This is particularly important to remember if you’re receiving the procedure outside of a medical space, such as is the case with an increasing number of vaccinations.

Influenza vaccines, commonly referred to as flu shots, are available in the U.S. at drug stores, grocery stores and workplaces. Should you choose to receive a flu shot at your office, for instance, and an adverse reaction occurs, there will be no medical staff on hand to come to your aid. Instead, you’ll be at the mercy of whoever is nearby to provide help, which will typically be to call 911.

This is precisely what happened to Matt Gleason, a healthy 30-something from North Carolina who received a flu shot at his workplace, then fainted five minutes later.

Man Faints After Flu Shot, Gets Hospital Bill for Thousands of Dollars

The flu shot offered at Gleason’s workplace in October 2018 was free, but the medical bills he racked up as a result were far from it. Gleason, who has a history of fainting but otherwise is in good health, fainted after receiving the flu shot. He came to quickly but his colleagues called 911 just in case.

When paramedics arrived, Gleason began vomiting, prompting them to transport him to a nearby hospital by ambulance. There he spent eight hours in the emergency room — primarily in the waiting area — where he spoke to a doctor via teleconference and received an electrocardiogram, chest X-ray and blood and urine tests.

Everything came back normal and Gleason was allowed to go home with a clean bill of health — and a steep ER bill too match.

As reported by NPR, Gleason’s total bill was as follows, “$4,692 for all the hospital care, including $2,961 for the ER admission fee, $400 for an EKG, $348 for a chest X-ray, $83 for a urinalysis and nearly $1,000 for various blood tests. Gleason’s insurer … negotiated discounts for the in-network hospital and reduced those costs to $3,711.”1

This is a cautionary tale not only for vaccination side effects but also the exorbitant costs of medical care in the U.S. Hospitals often use criteria for emergency room billing that’s based on a level system from 1 to 6, with 1 being the lowest level of care and 6 being critical care, such as a gunshot wound or major injuries from a car accident.

Gleason’s fainting episode was coded at level 5 — the second most expensive. While he argued that a lower level fee should have been charged, especially with the amount of time he spent in the waiting room, the hospital backed up its charge because he received at least three medical tests. According to NPR:2

“David McKenzie, reimbursement director at the American College of Emergency Physicians, said the guidelines were set up to help hospitals charge appropriately.

Asked if hospitals have an incentive to perform extra tests to get patients to a higher-cost billing code, McKenzie said: ‘It’s not a perfect system. Hospitals have an incentive to do a CT exam, and taxi drivers have an incentive to take the long way home.’”

How Common Is Fainting After Vaccination?

Fainting, medically known as syncope, is the temporary loss of consciousness as a result of decreased blood flow to the brain — and it’s quite common after vaccination.

According to the U.S. Centers for Disease Control and Prevention (CDC), fainting has been reported following nearly all vaccines, and the federal vaccine adverse event reporting system (VAERS) receives many reports of fainting following vaccination every year, with many more cases likely going unreported.3

Adolescents appear to be particularly at risk of fainting following vaccination, although the CDC doesn’t know why. More than half (62%) of fainting episodes following vaccination reported to VAERS involved adolescents 11 to 18 years old.4 Among this age group, fainting occurs most often following these three vaccines: HPV, MCV5 (meningococcal vaccine) and Tdap.

“Because the ingredients of these three vaccines are different, yet fainting is seen with all of them, scientists think that fainting is due to the vaccination process and not to the vaccines themselves,” according to the CDC. “However, there is not yet a definite answer about whether an ingredient of the vaccines is responsible for the fainting or if adolescents are simply more likely than children or adults to experience fainting.”5

While fainting itself is rarely serious, and most people regain consciousness and recover quickly, it can lead to fall-related injuries that can cause significant injury. In fact, the journal Vaccine lists fall-related injuries associated with fainting after vaccinations as one of the “rare cases where a known or plausible theoretical risk of death following vaccination exists.”6

A CDC report described one case study of a 13-year-old girl who fainted within 10 minutes of receiving HPV and MCV4 vaccinations. “She fell backward and hit her head on the carpeted floor of the clinic. The girl was admitted to the pediatric intensive-care unit because of skull fractures and subarachnoid hemorrhage.”7

Fainting-Related Falls After Vaccination Can Be Fatal

The girl recovered, but in another case reported in the Archives of Pediatrics and Adolescent Medicine, the child was not so lucky. The boy, who was 15 years old with no known medical problems, fainted several minutes after receiving the third dose of hepatitis B vaccine. He fell backward onto a concrete floor covered by a thin carpet, striking the back of his head.

He regained consciousness but had convulsions, went into cardiopulmonary arrest and died. An autopsy revealed he suffered from traumatic brain injury, including frontal lobe contusions, along with brain swelling and bleeding, even though he had no skull fracture.8 According to one study of vaccine-related fainting reported to VAERS, 7% of the reports were serious and 12% involved head injuries.

The CDC recommends that vaccine providers follow their Advisory Committee on Immunization Practices (ACIP) guidance, which suggests observing patients for 15 minutes after vaccination to prevent fainting-related injuries.9 However, it’s unclear how often this is actually done, not only in doctors’ offices but also in workplaces where vaccines are administered.

The CDC reported that nearly 70% of vaccine-related fainting episodes occurred within 15 minutes of vaccination, but this still means that 30% occurred after this timeframe — by which time a person could be in their car and driving, walking down stairs or engaging in a multitude of other activities that would pose a threat to themselves and others should fainting occur.10

They reported at least one case of a vehicle accident that occurred because the patient lost consciousness while driving. The problem is so widespread that the U.S. Food and Drug Administration (FDA) states the following in their information about Gardasil, an HPV vaccine:11

“Fainting is common after injections and vaccinations, especially in adolescents. Falls after syncope may sometimes cause serious injuries, such as head injuries, which can be prevented with simple steps, such as keeping the vaccinated person seated for up to 15 minutes after vaccination.

FDA and CDC have taken steps to remind immunization providers about the recommendation that individuals be watched carefully for 15 minutes after vaccination to avoid potential injury from a fall.

FDA approved revised labeling on June 9, 2009, to highlight this information in the Warnings and Precautions section, and new information was added noting that individuals who faint sometimes have tonic-clonic (jerking) movements and seizure-like activity.

As a part of a Back to School immunization campaign, FDA and CDC are also continuing to remind health care providers to take measures to prevent fainting and the possible traumatic injury resulting from fainting.”

What Other Adverse Events May Occur Following a Flu Vaccine?

Aside from fainting, flu vaccine most commonly causes fever, joint pain, muscle aches, nausea and headaches. It may also be associated with Guillain-Barre Syndrome (GBS), an autoimmune disease that can cause paralysis. Not only are vaccine injury claims related to the influenza vaccine the most common type submitted to VICP, but GBS is the leading injury in the claims.12

“The data on the association between GBS and seasonal flu vaccination are variable and inconsistent across flu seasons,” the CDC noted in 2015. “If there is an increased risk of GBS following flu vaccination it is small, on the order of one to two additional GBS cases per million doses of flu vaccine administered.”13 The National Vaccine Information Center (NVIC) further describes GBS as:14

“An immune mediated painful and disabling neurological disorder that can occur after viral infection or vaccination, GBS involves inflammation of the peripheral nervous system and can cause temporary or permanent paralysis that may lead to death. GBS usually develops within two to four weeks of vaccination.

Characterized by muscle weakness, unsteady gait, numbness, tingling, pain, GBS can cause paralysis of the face or one or more limbs. It can take several months for recovery or leave the affected person with chronic health problems and disability.”

Shoulder injury related to vaccine administration, or SIRVA, is another risk. A vaccine given in your shoulder is intended to go into your muscle. If it mistakenly goes into the bursa, a fluid-filled sac that protects your shoulder tendons, trouble can result. Specifically, the vaccine may provoke your immune system to attack the bursa, sometimes leading to debilitating symptoms.

In adults, SIRVA occurs most often after flu shots and other vaccines that a person has already received, which may pave the way for a heightened inflammatory response.15 GBS and SIRVA were both added to the Vaccine Injury Table in 2017.

By adding those vaccine complications to the table, vaccine-related GBS and SIRVA cases brought before the “Vaccine Court” in the U.S. Court of Federal Claims in Washington, D.C., will be more likely to receive federal vaccine injury compensation.

Flu vaccination during early pregnancy has also been linked in one study to an eightfold increased risk of miscarriage, particularly among women who had been vaccinated for the flu in the previous flu season as well.16

Flu vaccination may also increase your risk of contracting more serious flu infections, as research suggests those who have been vaccinated annually may be less protected than those with no prior flu vaccination history.17

Do the Benefits Outweigh the Risks?

The important question to ask, then, before choosing to receive a flu shot (or any other medical procedure) is whether or not the benefits outweigh the risks. In the case of the flu vaccine, the risk of adverse events — and their associated medical costs — is real. But what about its purported benefit — reducing your risk of the flu?

Be aware that in the decade between 2005 and 2015, the influenza vaccine was less than 50% effective more than half of the time.18 The 2017/2018 flu vaccine was another example of this less-than-impressive trend. The overall adjusted vaccine effectiveness against influenza A and B virus infection was just 36%.19

Fortunately, other methods exist to help you stay healthy during the flu season and all year, and they’re far safer than annual flu vaccination. Vitamin D testing and optimization have been shown to cut your risk of respiratory infections, including colds and flu, in half if you are vitamin D deficient, for instance.20,21

In my view, optimizing your vitamin D levels is one of the absolute best respiratory illness prevention and optimal health strategies available, and when combined with a healthy lifestyle represents one of the safest and most effective ways to stay healthy year-round.

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