Age: 40.0
Sex: F
Vaccine: FLU3, PPV, FLU3
Symptoms: Rash, Serum sickness, Urticaria
Clinical narrative: Information has been received from a 40 year old female with asthma, seasonal bronchitis, allergies to sulfisoxazole diolamine, nitrofurantoin, and prochlorperazine maleate, and a history of migraines, who on 12/10/03 was vaccinated with a 0.5ml dose in the right arm of pneumococcal 23v polysaccharide vaccine (lot # not reported). Concomitant vaccination included a dose of influenza virus vaccine (lot # 765885) in the left arm. Subsequently, on 12/10/03, the patient developed soreness at the location of the vaccination followed by a rash and hives on the right side of her body that reappeared once in April 2004, joint pain, and fatigue that she still experiences today. The patient reported that she sought unspecified medical attention and many laboratory tests were performed. The reporter indicated her experiences to be both disabling and life threatening. At the time of the report the patient had not recovered. There was no product quality complaint involved. Follow up information received from a health assistant indicated that, on 12/10/03, the patient did not have allergies to eggs, thimerosal, contact lens solution, or mercury. She has never had Guillain Barre syndrome. She did not have a fever or active infection. She did not have an active neurologic condition. She does not have a fever or active infection. She did not take an immunosuppresive therapy or have a condition that affects her immune system. She was not on a steroid medication. She did not have a history of latex sensitivity. She was not pregnant. The patient's body temperature was 97.3. Follow up information from a woman working at a physician's office indicated that, on 12/23/03, the patient was still on hydroxyzine hydrochloride, 25mg, 1 tablet TID for 10 days, 30 tablets, but it was the last day. The patient was on methylprednisolone. It was noted that the patient will be going to an allergist. Today, 12/23/03, was the first day without the antihistamine. Yesterday, on 12/22/03 (also reported as 12/10/03), the patient originally had no hives and got two. Last evening, on 12/22/03, the patient felt as if she had a tight chest. This morning, on 12/23/03, she is coughing and is still tight. The patient now, on 12/23/03, has pain in her hip, knee, and up and down her spine. It was also noted that when one touches her skin it is hypertender. The patient was well appearing, well nourished, and in no distress. She was oriented x3, in normal mood, and affect. Progress notes indicated that the patient had an ongoing reaction to pneumococcal 23v polysaccharide vaccine. She continued hydroxyzine hydrochloride, may try loratadine instead. The patient has had some discomfort during urination. It was noted that a urine culture will be performed. The patient is taking phenazopyridine hydrochloride. Follow up information from a physician indicated that, on 3/1/04, the patient was seen to discuss a pneumococcal 23v polysaccharide vaccine reaction. The patient was still having problems. Her knees, shoulders, elbows, and back were sore. The patient's energy is coming and she is doing more, uncomfortable. Her left arm and anterior chest was sore to the touch. The patient's asthma was controlled, she has not needed an inhaler with cough medicine. The patient felt that the antihistamine is helping with her asthma. She was not using any other antihistamines. Her right knee was swollen some, the left less so. It was noted that stairs bother her. The patient's chest is clear and she had no spinal tenderness. There was some soft tissue swelling above and lateral to her right knee. There was joint line tenderness. The patient could squat without pain. It was reported that the symptoms to the serum sickness reaction to pneumococcal 23v polysaccharide vaccine were slowly improving. The knee pain seemed to be part of the reaction. The option of part time was discussed. It was noted that the physician did not think she had arthritis. The physician also noted that an x-ray would not be useful. A MRI would only show if there was an injury. As there is no history and the symptoms are improving the physician did not see that the test was likely to benefit the patient. It was noted that if a stage was reached where the patient was not improving then it may need to be done. Medication was discussed. The patient liked thecarbinoxamine maleate (+) hydrocodone bitartrate (+) pseudoephedrine hydrochloride, 2tsp, every 4 hours, 8oz. The antihistamine helps with the asthma and other symptoms. Hydrocodone helps with the pain. The possibility of addiction was discussed, but the patient did not think that it was a problem. The carbinoxamine maleate (+) hydrocodone bitratrate (+) pseudoephedrine hydrochloride will continue for now. Additional information has been requested.