Age: 87.0
Sex: M
Vaccine: PPV
Symptoms: Pruritus, Red blood cell sedimentation rate
Clinical narrative: Information has been received from a medical assistant concerning an 87 year old male hypothyroid patient with allergy to sulfur, hypertension, high cholesterol, chronic obstructive pulmonary disease, and a history of coronary artery bypass graft, QUAD bypass and cataract surgery who on 13-JAN-2011 was vaccinated with a dose of PNEUMOVAX 23 (Lot # 665708/0651Z, expire date 15-JUN-2011), 0.5 ml, subcutaneously. Concomitant therapy included PLAVIX, BYSTOLIC, LIPITOR, AVALIDE, NIFEDICAL, levothyroxine NA, aspirin and fish oil. Medical assistant stated that the next Friday (on 14-JAN-2011) after vaccination with PNEUMOVAX 23, patient called the office to report he did not sleep well the whole night after receiving PNEUMOVAX 23 due to the pain and discomfort he felt in his arm. Medical assistant indicated that patient did not report any swelling, redness or fever in the first 24 hours following receipt PNEUMOVAX 23. Patient was instructed to apply cold compress (ice) for 10 minute intervals every couple of hours and call back if there was no improvement. Medical assistant mentioned that on Saturday 15-JAN-2011, the patient called the on-call physician to report he was still losing sleep and he had begun to have redness down the arm. Medical assistant mentioned that on Sunday 16-JAN-2011, patient reported that his arm began to swell and the redness increased all the way down the arm. Medical assistant also said that by Monday morning 17-JAN-2011, when the patient was seen by the doctor, the redness and swelling had began to subside (about 50% as reported by the patient) but for precautionary measures, the physician placed the patient on cephalexin and ordered a multitude of tests: comprehensive metabolic panel, sed rate, CBC, C-reactive protein, ANA (results not provided) to be certain the symptoms the patient was experiencing were not due to an underlying condition, that may have coincidently appeared at the time of the vaccination. At the time of the report, the patient was recovering. Follow-up information has been received from the medical assistant, who reported that the retired patient with no acute illness at the time of vaccination, who was vaccinated with a second dose of PNEUMOVAX 23 (Lot # 665708/0651Z), SQ, left arm on 13-JAN-2011 at 11:30. The medical assistant stated that on 14-JAN-2011 the patient experienced redness with itching, swelling of left elbow. The medical assistant also reported that the left upper arm had only a small bruise no indurations tenderness, or pain. The pain swelling, redness extended from left elbow to left middle upper arm and left forearm upper (2 inches) above left wrist that worse 2 days later, no fever, ice, elevation, KEFLEX initially and later oral prednisone was given as a treatment. The medical assistant also stated that the patient never had any shortness of breath or chest pain. At the time of the report the patient's outcome was unknown. The events required medical/surgical   [Due to memory limitations, the remainder of this text could not be compared.]  surgical intervention for several visit follow-up. Additional information has been requested.