Sudden death after typhoid and Japanese encephalitis vaccination in a young male taking pseudoephedrine

Mil Med. 1999 Feb;164(2):157-9.


The case of a 21-year-old male taking over-the-counter pseudoephedrine for weight loss who died suddenly during exercise shortly after inoculation with Japanese encephalitis and phenol-inactivated typhoid vaccines is presented. The patient collapsed in mild weather while exercising 75 minutes after his vaccinations. He presented in asystole with a core temperature of 42.2 degrees C (108 degrees F). There was no evidence of urticaria or angioedema. It is likely that the combined pyrogenic effects of the vaccines, pseudoephedrine, exercise, and mild obesity contributed to a failure of the thermoregulatory system. Fever is still a common side effect of numerous other vaccines. Military physicians should consider administrative controls on thermogenic activities for a period after inoculations. Additionally, the dangers of ephedrine-containing compounds need to be more widely publicized.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Appetite Depressants / adverse effects*
  • Cause of Death
  • Death, Sudden / etiology*
  • Encephalitis, Japanese / immunology*
  • Ephedrine / adverse effects*
  • Exercise*
  • Heat Stress Disorders / etiology*
  • Humans
  • Male
  • Military Personnel*
  • Obesity / complications*
  • Obesity / drug therapy
  • Typhoid-Paratyphoid Vaccines / adverse effects*
  • Viral Vaccines / adverse effects*


  • Appetite Depressants
  • Typhoid-Paratyphoid Vaccines
  • Viral Vaccines
  • Ephedrine