Age: 0.57
Sex: M
Vaccine: DTAP, HIBV, IPV
Symptoms: Skin ulcer, Viral infection
Clinical narrative: Initial information received on Oct 25 2005 from another manufacture (reference number WAES0409USA01252). It was initially reported by a health care professional that a six month old male patient with a medical history of sulfa allergy, asthma and strabismus received on Feb 28 2000 an injection in the left vastus lateralis IPOL, lot number P02422, intramuscularly in the right thigh, Hib vaccine, unspecified manufacturer, lot UA460AA, and intramuscularly in the left thigh, Infanrix, lot number A17A2. Subsequently, the patient received on Aug 10 2000 subcutaneously in the right thigh varicella virus vaccine, lot number 632718/1856J, subcutaneously in the right thigh MMR vaccine, lot number RA27/3, and intramuscularly in the left thigh pneumococcal vaccine Prevenar, lot number 471215. Information received from a physician showed the patient was admitted to the hospital from Dec 18 2002 to Dec 19 2002 for dehydration and listlessness and was diagnosed with shingles clinically. No laboratory tests were obtained. It was felt to be herpes zoster over the ophthalmic branch of his left trigeminal nerve having had only the varicella virus vaccine live previously. He was given intravenous acyclovir and sent home on four days of oral acyclovir. It was noted on Dec 30 2002 that since his hospitalization he had been very active but was scratching and itching his lesions. He had been taking oral Benadryl without help. He tried hydrocortisone for about one day but stopped because it did not help. The mother was concerned that his shingles were spreading across his forehead. He had a decreased appetite but was eating okay and had normal urination. His shingles also affected his left eye. Initially, it was red and then he had mild ptosis of the left eyelid and occasionally complained of left eye pain. It was noted that he had surgery at about two years of age for left esotropia. Upon physical exam on Dec 30 2002, he looked healthy and had healing lesions on his nose and to the left midline on his upper nose, medical to the left eye and forehead. the lesions were flat mildly erythematous macules. He had numerous excoriation's by the lesions. No papules were seen. he had normal extraocular movement and grossly normal vision. It was noted that he wore eyeglasses. For itchiness he was prescribed Atarax and advised to discontinue Benadryl. He was also to try calamine and Aveeno cream. Because of his mild ptosis, he was referred to ophthalmology. On Dec 31 2002, he was seen by an ophthalmologist. His eye was injected and swollen with nor corneal involvement. The mother noted that the left eyelid had been drooping since the shingles episode and thought it would resolve with treatment, but it had not. His medications at the time included albuterol and Intal nebulizer. His vision was 20/30 in both eyes with no afferent pupillary defect. He had full extraocular movement in both eyes. A slit lamp exam of the left eye was performed. He had ptosis of the left eye, mild edema of the left upper lid, multiple non active scab lesions, and no pus over the left forehead, left medial canthal area or tip of the nose. He had resolving varicella zoster virus conjunctivitis and facial lesions with ptosis secondary to inflammation. He was started on prednisolone acetate BID in the left eye to control inflammation. It was noted that the ptosis would likely resolve as the varicella zoster virus healed. On Jul 26 2004, he was seen by the reporter for foot pain and bumps, blisters, warts on the bottom of his feet. He had lesions on the plantar surfaces of booth feet that were present for about four days. The mother related them to his being outside bare footed on Jul 24 2004 and Jul 25 2004. The patient said that he may have been stung by something but denied any bleeding from the foot. He was noted to be on montelukast sodium and albuterol prm rarely for asthma. His skin and good turgor and was clear except for bullous lesions with concentric subtle rings over the fluid filled bulla with a central puncture. Tow of these were approximately one centimeter in size on the mid plantar surface of the left foot, and there were lesser and less distinct lesions on the right foot. It was noted that a varicella zoster fluorescent antibody test of the bullous lesion of the foot was positive for varicella zoster. The impression was bullous lesions on the feet and persistent strabismus even when in his glasses. He was diagnosed with bullous impetigo. He was placed on cephalexin. He recovered within one week of the second episode. Subsequently, the patient received initial doses on Aug 10 2000 of Varicella virus vaccine, manufacturer number RA27/3. subcutaneously in the right thigh, MMR vaccine, lot number Ra27/3, subcutaneously in the right thigh, and Prevnar, lot number 471215, intramuscularly in the left thigh. At the time of this report, the patient had recovered.