Age: 75.0
Sex: F
Vaccine: PPV
Symptoms: Blood sodium normal, Blood urea increased, Breath sounds abnormal, Cellulitis, Chest X-ray normal
Clinical narrative: This spontaneous report as received from a Licensed Practical Nurse via company representative refers to a patient of unknown age and gender. In 2013 (date unspecified) the patient was vaccinated with a dose of PNEUMOVAX23, injection (strength, dose, route, lot number and expiration date not provided). The nurse reported that the patient had adverse reactions (type of reaction unspecified) with in the last couple of weeks (in 2013, date unspecified) to PNEUMOVAX23. The patient sought medical attention and was hospitalized (reason and duration of hospitalization was unspecified) following vaccination with PNEUMOVAX23. The outcome of adverse reactions was not reported. The relatedness between vaccination with PNEUMOVAX23 and adverse reactions was not reported. The adverse event had been provided to the Vaccine Adverse Event Reporting System (VAERS). This is one of two reports from the same source (#1312USA005018). Follow up received from Licensed practical nurse (LPN). The LPN did not have any information to share at the time of this report. Additional information has been received from Licensed Practical Nurse concerning to a 75 year old female patient (occupation: retired). Approximately three years ago patient had a flu shot (manufacturer unknown) on her right arm, which caused swelling and pain. (MARRS# 1403USA000990). On 08-NOV-2013, at 3:49 pm, the patient was vaccinated with the first dose of PNEUMOVAX23 lot # J004747 in the left deltoid. On 08-NOV-2013 at 9:30 the patient experienced fever of 102, swelling in arm, cellulitis, tenderness and erythema (102 fever, swelling in arm, and cellulitis were also reported as the illness at time of vaccination). Patient visit emergency room, and from 10-NOV-2013, the patient was hospitalized for 5 days. On 15-NOV-2013, the patient was recovered from events. Patient's hospital medical record was provided: CHIEF COMPLAINT: Left arm swelling, pain, and fever. HISTORY OF PRESENT ILLNESS: A 75-year-old female with a past medical history for asthma who presenting with pain after a pneumonia shot. She stated she was just given on Friday. That evening, she started getting swelling and pain. She did put ice on it trying to make it get better. She had noted the past day it has gotten worse, worsening swelling all the way up into the back and neck with tenderness. She also had fever of 102 at home and with that, she presented her to the emergency room where it was felt to be possible cellulitis. We are consulted for admission. The patient also related she had a similar incident approximately three years ago when she had a flu shot on her right arm, which caused swelling and pain. She stated even though it has been three years ago, it still caused her difficulty and she would not take any shots in that arm anymore. PAST MEDICAL HISTORY: Significant for hypothyroidism; asthma; history of diverticulitis in the past; depression; degenerative disk disease; chronic low back pain; history of retro-colon cancer, status post treatment for same; C-section; hysterectomy; cholecystectomy; appendectomy; and right total knee arthroplasty. ALLERGIES: Her allergies were to codeine, erythromycin, hydrocodone, iodine, latex, LEVAQUIN, penicillin, sulfa, and tetracycline. MEDICATIONS: Her home medications were meclizine PRN, PROLIA IM every six months, TYLENOL, ergocalciferol on Wednesdays and Sundays, dicyclomine PRN, ashwagandha, bacopa, milk thistle, tea, PROTANDIM PRN, stool softener, SYNTHROID 50 mcg daily, amlodipine 5 mg daily, CYTOMEL 5 mcg daily, ALIGN daily, ZOFRAN PRN, magnesium oxide 200 mg daily, CELEBREX 200 mg daily PRN, and omeprazole (manufacturer unknown) 20 mg twice a day. She takes SYMBICORT PRN, SINGULAIR 10 mg at bedtime, CRESTOR 10 mg at bedtime, vitamin B12, multivitamin, vitamin D, losartan potassium (+) hydrochlorothiazide (manufacturer unknown) 12.5/100 mg daily, clonazepam 1 mg at bedtime, METAMUCIL twice a day, and multivitamin with minerals twice a day. FAMILY HISTORY: Reviewed and noncontributory. SOCIAL HISTORY: No tobacco or alcohol. REVIEW OF SYSTEMS: As above. CONSTITUTIONAL: No significant weight changes or fevers. EYES: No change in vision, glaucoma or cataracts. ENT: No hearing loss, frequent sinus trouble, tinnitus or vertigo. CARDIOVASCULAR: No chest pain, palpitations, shortness of breath, paroxysmal nocturnal dyspnea, orthopnea or ankle swelling. RESPIRATORY: No cough, wheeze, or hemoptysis. GASTROINTESTINAL: No heartburn, nausea, vomiting, constipation, diarrhea, abdominal pain, jaundice, melena or hematochezia. GU: No dysuria, urgency, frequency, or kidney stones. HEMATOLOGICAL LYMPH: No easy bruising or bleeding, or swollen glands. MUSCULOSKELETAL: No myalgia or arthralgia. SKIN: No new rashes or skin breakdown. NEUROLOGICAL: No seizures, localized weakness or numbness. PSYCHIATRIC: No anxiety or depression. PHYSICAL EXAMINATION: VITAL SIGNS: On presentation to emergency room, temperature was 101.1, blood pressure 115/58, pulse 75, respiratory rate 20, and O2 saturation 96%. GENERAL: Patient appears to be in no acute disease. She is alert and oriented x3, talking in full sentences. Her family is present at the bedside. HEENT: Normocephalic, atraumatic. PERRL. Anicteric. Moist mucous membranes. NECK: Supple. There is no JVD or bruits. Trachea is midline. Thyroid nonpalpable. LYMPHATICS: No cervical or supraclavicular lymphadenopathy appreciated. CHEST: Unlabored. Decreased breath sounds bilaterally, but no rhonchi or wheeze. HEART: Regular rate and rhythm. S1, S2. No murmur. ABDOMEN: Positive bowel sounds. Soft and nontender. No rebound. No guarding. No hepatosplenomegaly appreciated. EXTREMITIES: No clubbing, cyanosis, or edema. NEUROLOGIC: Cranial nerves II through XII are grossly intact. No focal deficit. Muscle strength is roughly 4/5 bilateral upper and lower extremities. Her left arm did show marked area of erythema and tenderness. I did not appreciate any fluctuance. This extends to the back with erythema. LABORATORY: A chest x-ray was done, which showed normal chest x-ray. Lab work shows white blood cell count of 15, hemoglobin 12, hematocrit 37, and platelets 188,000, Sodium 136, potassium 3.6, chloride 103, bicarbonate 25, glucose 97, BUN 11, and creatinine 0.5. ASSESSMENT PLAN: Fever and erythema, concern for cellulitis. The patient will be started on empiric antibiotic therapy. We will also consult infection disease to assist with treatment and plan. This was all reviewed with the patient and the family, and they agree with the assessment and plan as outlined above. All available medical records will be provided upon request. Additional information is not expected.