Age: 12.0
Sex: M
Vaccine: VARCEL
Symptoms: Fatigue, Headache, Nasal congestion, Nausea, Pain
Clinical narrative: Information has been received from a physician concerning a 12 year old male with allergic rhinitis and no known drug allergies who on 08/07/2001 was vaccinated in the right arm with the first dose of varicella virus vaccine live. On 08/23/2001 the pt presented to the physician's office and medical records indicated that he had developed chills, headache and clear nasal discharge with moderate nasal congestion on 08/13/201. Over the next couple of days he had widespread aches, chest congestion and a nonproductive cough. It was noted that over the last 3-4 days, his cough had worsened. He had occasional nausea, but no postussive vomiting. He did not have any fever or sweats, there had been no rash, and his symptoms had been moderate. His mother treated him with  Robitussin DM and Tylenol. It was reported that several household contacts had recently been ill with respiratory illnesses, primarily colds, but that none of them had the severe cough that the pt developed. Upon review of his symptoms, the physician noted that the pt had occasional dizziness and had been markedly fatigued. There had been no diarrhea, but the pt had mild abdominal pain, particularly with coughing. The physician found that the pt had some fairly large skin tags on the underside of his tongue, and that his posterior pharynx was moderately cobblestoned and erythematous. The pt had some crackles in the left mid to upper lung fields, and possibly an expiratory wheeze, but this was not consistent. His abdomen was soft and mildly tender in the epigastrium without masses, organomegaly, guarding or rebound tenderness. A chest x-ray, PA and lateral, showed possible subtle infiltrate in the left perihilar area and occasional small areas of atelectasis in the same region. See lab section for other lab findings on 08/23/2001. The pt was assessed as having "lingular pneumonia versus possible pneumonitis from varicella vaccine." He was prescribed Zithromax 250 mg daily for 8 days and was told to use Robitussin with codeine prn severe cough at night. The physician would consider albuterol if the cough did not respond. On 09/05/2001, the pt presented to the physician's office for a follow-up visit. Medical records indicated that the pt's mother reported that the pt had improved significantly while on the Zithromax, but three to four days ago, began to get worse again and had increased nasal congestion, sneezing, itchy eyes and cough. The cough had been productive of some whitish sputum. There was no shortness of breath or chest pain. The pt continued to use the Robitussin with codeine with fairly good results until it "ran out yesterday." The pt was afebrile, and did not have chills. No shortness of breath, GI upset, ear pain, sore throat or hoarseness were noted. Upon observation, the physician noted that the pt was in no acute distress. Head and neck exams showed some clear fluid behind the left tympanic membrane, otherwise, the external canals and tympanic membrane were unremarkable. The posterior pharynx was still moderately cobblestoned and erythematous, and the lungs showed a few crackles on the left but no change to percussion. There was good air movement and no wheezes with forced expiration. His heart rate was regular without murmur or gallop. A chest X-ray, PA and lateral, showed continued verymild right middle lobe infiltrate. see lab section for other lab findings on 09/05/2001. The pt was assessed with worsenng allergic rhinitis and improving pneumonia. he was prescribed prednisone 20mg a day for 5 days if he was not significantly better in 48 hrs. He was told to ocntinue the Robitussin with codeine, and to use Claritin 10mg once a day and Sudafed prn congestion. The Zithromax was continued for another 5 days, and the pt was to return if he did not improve. At that time, an allergy referral was to be considered. Subsequently, the pt recovered. The physician felt that possible pneumonitis was related to the therapy with varicella virus vaccine live. No further info is available.