"He was a very energetic child. Even the day he got the shot, he was running around, singing and playing. It was only late at night that he suddenly fell very sick," says Joanna Lobo, aunt of two-year-old David Dominic Lobo, from Goa's Mapusa.
On 20 December 2023, David received the yellow fever vaccine along with his father. Within 24 hours, on 21 December, David was no more.
"Everyone told us that it was a very safe vaccine. If that's the case, why isn't our David with us anymore?"Joanna Lobo
Nearly two months after the toddler's shocking and unexpected death, the family is still seeking answers.
What Happened to David?
The Lobo family was preparing to attend a wedding in Nairobi, Kenya from 10-20 January. Taking the yellow fever vaccine was part of the medical requirement for the travel.
Speaking to FIT, David's mother Larissa Menezes recounts, "My son was less than two years old, so I consulted with his paediatrician in Mapusa to ask if it was safe for him to take it."
She says the doctor gave them a green signal and told them that it was completely safe.
According to Larissa, the vaccination process went smoothly. "They made us fill a form, after which we had to visit a general physician who cleared us for the vaccine."
"On 6 December when we all made our appointments, my son, David, had a runny nose so they didn't clear him that day. We went a few days later (20 December) when his symptoms had subsided, and they cleared him for the vaccine then."Larissa Menezes
"They gave him the shot and said they would keep him for longer under observation to check for any allergic reactions because he was so young. Nothing happened, so we came back home," she says.
"Till 11:30 pm, David was active. I was preoccupied with the planning for our trip, but he was running around with his toys, he played with his grandparents, and with his father when he came back from work. He was his usual self."Larissa Menezes
"At around 3:30 am, he woke up feeling very uncomfortable, crying in pain, and he vomited three times," says Larissa.
She goes on to say that they managed to calm him down and put him back to sleep. "He slept for a few more hours, but he was restless and fidgety throughout."
At 8:30 am when Larissa woke up next, she says David vomited again. "He looked very pale and yellow. I looked closer and he was panting in his sleep."
She immediately decided to rush him to the doctor. The family went to a chest specialist first, who asked them to take David to a hospital. From there they went to the Casualty Department at North Goa District Hospital Asilo in Mapusa.
"The doctor at the Casualty didn't check David when we brought him in. She, instead, asked us to make case papers and go to the paediatric outpatient department (OPD), completely disregarding what I was telling her about David's condition."
"At the OPD they checked his respiration rate which was very high, and he had a fever of 104oF. We were asked to return to the Casualty and that we would have to admit him," Larissa recounts.
According to Larissa, things started going rapidly downhill from there.
"As I lay him on the bed, he had a seizure and he fainted. The nurses tried to give him IV, and I was asked to leave the room."Larissa Menezes
Larissa says she doesn't remember much of what happened from then on, just the urgency with which the doctors moved and the image of her son struggling to breathe from just minutes before.
"I broke down then. They tried to give him life-saving drugs and they intubated him, but his heart stopped, and he had stopped breathing."Larissa Menezes
'Weren't Warned About Adverse Affects'
While waiting for their turn at the vaccine centre, Larissa says she remembers being surprised by how frequently people came in to take the yellow fever vaccine.
The yellow fever vaccine was first introduced in 1938 and has since been widely used all over the world.
"It's an old vaccine that millions of people have taken all over the world, and there have been very few adverse effects associated with this vaccine," says Dr Vineeta Bal, a scientist at the National Institute of Immunology, who was not involved in this case.
She goes on to say that "contracting yellow fever itself from the vaccine is unlikely, and even if it were the case, the virus has an incubation period of 3-4 days before the symptoms present itself."
An adverse event, on the other hand, is rare but possible, usually manifesting within 3 days of vaccination.
"However, as a statistical probability, the events of fatality from this particular vaccine are very rare."Dr Vineeta Bal, Scientist, National Institute of Immunology, Delhi
Since 1938, there have only been around 62 confirmed cases of fatalities linked to the vaccine in the world.
"We haven't had any fatalities here till now," Dr Uttam Desai, Chief Medical Officer of the Directorate of Health Services (DHS), Goa, tells FIT. But, he adds, "Adverse effects are adverse effects. We don't know what can trigger them many times."
According to the US Centres for Disease Control and Prevention, around 1 in 250,000 people tend to get "yellow fever vaccine-associated viscerotropic disease" – leading to a serious damage to internal organs.
When asked about whether vaccine recipients are informed beforehand about the possible adverse events that could occur, Dr Desai said,
"In vaccination, we inform all parents about the symptoms that can arise after taking the vaccine. We tell them about all the adverse effects that can occur. Rare, dangerous, everything. This is a routine thing."
However, according to Larissa, the family had not been informed about the adverse effects linked to it before they got their shots. "There were no instructions from them after the shot either," Larissa adds.
Could David Have Been Saved?
The family also alleges medical negligence by the doctor in charge at the Casualty department of North Goa District Hospital Asilo, where David was taken after he fell sick.
"We wasted so much time in going to the paediatric OPD and getting the paperwork done, only to return to the Casualty because she didn't even check David when we came in."Larissa Menezes
She goes on to say that the family lodged a formal complaint of medical negligence against the doctor with the Medical Superintendent of the hospital.
When asked about any investigation that was carried out following the complaint, Dr Vandana Dhume, Medical Superintendent at the District Hospital, told FIT, "We did the initial investigation and forwarded everything to the DHS' vigilance cell."
As for action taken against the doctor on call who was named in the complaint, she responded, "I have not received any correspondence from the DHS on the matter." She refused to comment beyond that.
'We Still Don't Know the Exact Cause of His Death'
"In his death certificate, they wrote myocarditis with a question mark. We still don't know what exactly caused his death."Larissa Menezes
Apart from a possible reaction to the vaccine itself, there are other variables that could have caused David's death.
For instance, did he have any other underlying condition that was triggered by the vaccine? Was the vial contaminated or compromised?
According to David's mother, the child did not have any health conditions that they were aware of. "He was a very healthy, energetic baby."
She goes on to say that bacterial and viral panel tests, including a COVID test, were done after his death to check for any pre-existing infection that could have been triggered by the vaccine. "They all came negative."
As for contamination, "Five people, including my husband, received the vaccine from the same vial that was used for David. They were observed, and we were told none of them had any reaction," says Larissa.
The family, however, was assured that the contents of the vaccine vials from the same batch are being tested and that the test results would be shared with them.
When asked about the tests being run by the DHS, Dr Desai told FIT that the causality findings are kept secret and that the meeting is yet to happen.
The family declined to get an autopsy of the child.
"I wouldn't blame the doctors for not knowing the cause because it all happened so quickly. It's no one's fault. But I still would want to know the cause. How a child who was doing just fine one day dies within hours of taking a vaccine, with no particular cause," says Joanna.
"We want everyone to be aware that this is a possibility, even if it's rare, once someone takes the vaccine."Larissa Menezes