Table 7 Reports of death after FabAV administration reported to the US National Poison Data System, 2000–2006

A 17-year-old girl presented after apparent intravascular envenomation by an unknown snake with features of anaphylaxis to venom. Within minutes, she was hypotensive, profoundly hypoxic, developed pulmonary edema, and had a seizure. Treatment included intubation with ventilator support, dopamine, and FabAV (dose not reported). She never developed local tissue effects or coagulopathy. Despite maximal therapy, she died five days after envenomation.

A 43-year-old man presented with severe hypotension after a rattlesnake bite. He remained hypotensive despite fluids, dopamine, epinephrine, diphenhydramine, steroids, and 26 vials of whole-IgG antivenom. Disseminated intravascular coagulopathy developed. He then received six vials of FabAV, after which his blood pressure improved such that vasopressors were discontinued. He developed epistaxis and oral mucosal bleeding that was treated with 7 additional vials of whole-IgG antivenom and transfusions of platelets, fresh frozen plasma, and cryoprecipitate (response not reported). He developed renal failure, and ultimately died of multi-system organ failure.

A 33-year-old man received FabAV for an apparently uncomplicated rattlesnake envenomation. He was discharged from the hospital 24 hours later with only minimal symptoms, and was given a prescription for oxycodone with acetaminophen. He died of an apparent overdose of oxycodone that night.

A 52-year-old man presented with a forearm compartment syndrome due to a copperhead snakebite. He received FabAV and underwent a dermotomy of his finger and a fasciotomy of his arm. Subsequently, he developed severe alcohol withdrawal, which was treated with diazepam, haloperidol, and fentanyl, which led to respiratory arrest, aspiration, and acute respiratory distress syndrome. Medical care was withdrawn, and the patient died.

A 55-year-old man presented with severe hypotension and coma from apparent intravascular envenomation from a rattlesnake. FabAV therapy and aggressive resuscitation were not initiated for several hours. The patient developed renal failure, disseminated intravascular coagulopathy, and circulatory collapse, and died seven hours after envenomation.

Patients Treated with Unspecified Antivenom

A 30-year-old man presented comatose after rattlesnake envenomation. On presentation, he was found to have coagulopathy, thrombocytopenia, and a subarachnoid hemorrhage. He received "10 to 20 vials" of unspecified antivenom, but died after withdrawal of life support.

A 32-year-old man presented to the emergency department in respiratory arrest due to anaphylaxis from a rattlesnake bite. He received unspecified antivenom, and subsequently died of anoxic encephalopathy.