Age: 0.23
Sex: M
Vaccine: DTAPIPVHIB, IPV
Symptoms: Rhinitis allergic, Skin exfoliation, Skin test positive, Sleep disorder, Urticaria
Clinical narrative: Based on additional information received on 24 August 2015, this case became medically confirmed. Initial unsolicited report received from a non-healthcare professional on 09 June 2015. A four months old male patient, whose medical history and concomitant medications were not reported, had received first dose of PENTACEL (batch number C4828AA and expiry date, site of administration was unknown) via intramuscular route on 24 April 2015. The patient also received the first dose of IPOL (batch number K1694 and expiry date, route and site of administration was unknown) on the same day on 24 April 2015. Thus it was an overdose for IPV. It was reported that patient had no reactions post vaccination, however two months after vaccination, the patient developed contact dermatitis and the patient's mother was trying to claim the two doses of IPV administered in April as the cause. It was reported that patient required ER/doctor visit. Laboratory investigations and corrective treatments were not reported. At the time of this report, outcome of the event was unknown. Documents held by sender: none. Follow up information received from a physician on 24 August 2015. Patient age corrected in this follow-up (initial it was reported as 5). Patient had no known drug allergies, allergy to egg and milk products. Past medical history was neonatal jaundice, congenital lacrimal duct obstruction of the right eye, eczema, RSV bronchiolitis. It was reported that, 4 month old baby had immediately broken out in really awful large hives after drinking similac breast feeding supplemental formula. Patient around 3 month old got a dose of polio vaccine and started getting eczema and some scattered rashes, worsened, so changed to free detergents, rash continued to worsen, and was fussy. It was reported that, patient was sensitive to dove and was not bathing as often and also started oatmeal cereal, started avoiding some foods so milk supply went down, so supplemented with Similac Breast Feeding Supplemental formula (has prebiotics), but patient developed hives within minutes of drinking. Rash initially was blotchy and flat, changing mom's diet to soy formula has improved rashes. Altering before had scratch marks everywhere and was more fussy and more rashy both hives, eczema and flat blotches. Patient had eczema, usually at torso, some on arms legs, skin is very itchy, affects sleep. And the medications was OTC lotions, hydrocortisones (HC) cream and Zyrtec. Patient's born at term, 38 weeks, cesarean stayed three days and had rough pregnancy. On 09 July 2015, patient had concomitant medication Zyrtec children allergy 5mg/5ml, oral syrup 1/4 tsp (two times a day) Bid. On an unspecified date, following vaccination the patient experienced erythematous rash most notable on anterior trunk, some on upper arms and back, and some on neck and also had few eczema patches on face. The patient had scaling in his scalp and there are faint erythematous patches on the trunk and there is white scale in the scalp. Patient was also diagnosed with atopic dermatitis and allergic rhinitis due to dogs. It was reported that, allergy skin testing was performed by the skin prick method to a panel of one aeroallergens, eleven food allergens and a positive and a negative control results showed allergic hypersensitivity to: milk, casein, whole egg, egg yolk, egg white: also to dog dander. Negative to wheat oat, soybean, rye, barley chicken. Review of systems constitutional reported as negative for eyes, ENT (ear nose throat), cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary, neurological, psychiatric, endocrine negative and hematologic/lymphatic. Patient had other lab investigation as weight: 16.31b Ht: 24.5 in body mass index (BMI): 19.1 Temp: 98.8F and Height: 27 Inch, 0-24 Length Percentile 86 percent, weight: 19 lb 4 oz, 0-24, weight percentile: 90 percent, body mass index (BMI) Calculated: 18.57 88A Calculated: 0.39, Temperature: 98.6 F, Respiration: 18. Other laboratory investigation (Physical Exam) Constitutional: alert and in no acute distress. Head and Face: the head and face were normal in appearance and no sinus, tenderness, palpitation. Eyes: the sclera and conjunctiva were normal and pupils were equal in size, round, reactive to light, with normal accommodation. ENT: both tympanic membranes were normal, the nasal mucosa and septum were normal and the teeth and gums were normal. The right tympanic-membrane was obscured partially by cerumen. The left tympanic membrane was obscured partially by cerumen. There was clear rhinorrhea from both nares. The bilateral nasal mucosa was pale/blue. The oropharynx was normal. Neck: the appearance of the neck was normal, no neck mass was observed, the thyroid was not enlarged and there were no palpable thyroid nodules. There was no jugular-venous distention. Pulmonary: no respiratory distress, normal respiratory rhythm and effort and clear bilateral breath sound. Cardiovascular: heart rate and rhythm were normal, normal 81 and 82 and no murmurs. The arterial pulses were normal. Abdomen: normal bowel sounds, soft, non-tender. No hepato-splenomegaly and no abdominal mass palpated. Lymphatics: The posterior cervical, anterior cervical, supraclavicular, axillary, femoral and inguinal nodes were non-tender and normal size. Extremities: no clubbing of the fingernails, no localized cyanosis, no petechial hemorrhages and no ischemic changes. Skin: normal skin color and pigmentation, normal skin turgor, no rash and no skin lesions. (diffuses dry/greasy baby eczema, with small papules scattered, esp red base of neck, right axillae). Neurological: The patient was oriented to person, place, and time. Mood and affect were appropriate. Corrective treatment for food allergy to milk and egg and the patient was to avoid all foods, drinks, lotions and cosmetics containing milk and egg, to keep a current injectable epinephrine JR two PK with patient at all times, and to wear a Medic Alert bracelet and also Benadryl, for allergic rhinitis to dog dander patient does indeed have allergies aggravating upper respiratory and skin symptoms and was directed to use saline nasal spray as needed (prn) and to use cetirizine 1/4 tsp BID, for atopic dermatitis patient may use hydrocortisone (HC) cream 0.1 percent two times a day (BID) prn- avoid on face, axilla and groin areas. Prevention of Atopic Disorders supplements such as vitamin D, omega 3 FA and probiotics may have a place in atopic disorders- prevention and/or treatment and also reported Eucerin products has propylene glycol and lanolin and this was stopped baby moisturizer, cerave cleanser or dove soap was continued and also hypoallergenic diet and atopic dermatitis information given. Patient was recommend with one percent hydrocortisone ointment for any more active area discussion with parents about the expected course of treatment. Patient was explained that it was a hereditary problem. Allergy Magazine given and egg allergic patients may receive the routine flu shot injection. For dermatitis patient may use moisturizer and used very light dose of topical OTC cortisone to trunk BID for the next few day and wear launder clothing that was previously washed in other detergent with fabric softener and was instruct care givers to avoid contact with scented soaps.