Age: 12.0
Sex: M
Vaccine: MNQ, MNQ, TD
Symptoms: Blood pressure increased, Cyanosis, Fatigue, Headache, Influenza like illness
Clinical narrative: Initial report received on 31 August 2007 from a health care professional in the United States. A 12 Year old male patient received on 29 August 2007 first dose of Menactra (lot # not reported) and experienced blue tinged on and off on different parts of his body: legs, arms and around the mouth. This occurred post vaccination. The patient was evaluated twice in the Emergency Room (ER) and "nothing was found to be abnormal." Only the mother saw that blue tinge. Pule Oxygen at room temperature was normal (at the ER). The patient had unspecified "problems" as a child. According to the reporter, the event was unrelated to Menactra. The patient's outcome was not reported. Follow-up information was received from a health care professional on 11 September 2007. On 28 August 2007 the patient received an intramuscular right deltoid injection of Tetanus and Diptheria Toxoid (lot number and manufacturer no reported). The following day, 29 August 2007, the patient had received an intramuscular left deltoid injection of Menactra, lot number U2367AA. The patient's last tetanus vaccination was unknown and the patient was reported as having no illness at the time of vaccination. Per the mother of the patient, on 29 August 2007, "two hours after the shot, (her son) had headache, bluish around mouth, legs and left arm where shot was given, achy all over. The mother took him to the emergency room (ER), patient complained of tiredness, no appetite, bluish legs with increased walking , and left arm was very painful and bluish". Mother stated he was treated for flu-like symptoms and released. The following day, 30 August 2007, the mother stated she took the patient back to the ER for blood work. The mother indicated, "her son's left arm was less painful and he was less achy but (he was) still tired, sleepy and bluish at times". He was released and instructed to follow up with primary care physician if not better in two to three days. The mother contacted their physician on 312 August 2007 stating, "his legs had bluish tinge in past, left arm and around mouth no before. Has been on medicine for hypothyroidism which he stopped taking a few months ago". Corrective treatment included directive that her son needs to take his prescribed medicine, fluids, Tylenol for achiness, and cold compresses for his sore left arm. Emergency room (ER) notes as follows: On 29 August 2007, the patient was taken to the emergency room (ER) and evaluated. According to the ER physician assessment notes, "vital signs were normal, oxygen sat 100%, and patient was afebrile. He was awake, alert and in no acute distress. Full range of motion was demonstrated in all extremities. There was no cyanosis or edema present in any of the extremities. The injection site and both the left and right deltoids were assessed and there was no evidence of local reaction. The patient had some mild tenderness in the musculature. Impression: There is an average reaction, specifically polymyalgias status post vaccinations". Treatments recommended: Tylenol and Motrin as needed for pain, plenty of sleep and fluids. A second ER visit occurred on 30 August 2007. Vital signs: BP 111/72, Pulse 106, Resp 24, Pulse Ox 99%. " The patient presented with random white spots on legs, symptoms began today. Assessment findings positive for weakness, tingling in extremities and weakness in arms and legs last night. Resolved today. The patient had yellowish nasal drainage noted, body aches and scattered white macules on lower left leg. The lesions were described as "well circumscribed discrete lesions 1 1/2-2cm in diameter, flat non-scaling, located on left shin". Pulse oximetry 99%, and cardiovascular and respiratory exam-all normal findings. Final impression: "Tinea Vesicolor, myalgias, secondary to immunizations. Patient discharged to home/self care in stable condition with instructions on rash, generic. Follow up: Private MD inf not better two to three days". ER notes indicated that the patient has a history of hypothyroidism, anxiety, asthma, and possible seizures and had allergies to sulfonamides, Valium, Depakoke, and meningitis vaccine. Additional information was not provided and patient was listed as recovered from the event at the time of the report. Documents held by sender: ER notes, private physician notes.