Age: 86.0
Sex: F
Vaccine: PPV
Symptoms: White blood cell disorder
Clinical narrative: Information has been received from a health professional concerning an 86 year old white female nursing home resident with an allergy to Macrobid, Parkinson's disease, diabetes, oxygen use, COPD, psychotic disorder, depression, spinal stenosis, constipation, hypertension arterial, hypothyroidism, schizoaffective disorder and questionable nutrition and a history of transient ischaemic attack, breast operation and breast cancer who on 26Mar05 during a 7-3 shift was vaccinated SC into the right gluteus with a second dose of pneumococcal 23 v polysaccharide vaccine (lot 650087/0815P). There was, reportedly, no acute illness at the time of vaccination. Concomitant therapy included Two Cal, calcium, carbidopa/levodopa (Sinemet), clozapine (Clozaril), Mg OH, venlafaxine HC1 (Effexor), morphine S04 (Ms Contin), temazepam (Restoril) and potassium chloride (Micro K). On 29Mar05 the pt complained of an non productive cough, on 31Mar05 she had an increased temp, crackles and wheezes in lung fields at 5:00AM and by 6:10PM was sent to the ER in respiratory distress. Per the hospital record it was noted that the pt arrived in the ER at 6:45 PM on 31Mar05 in respiratory distress following a witnessed episode of choking on food from that morning. The pt became hypoxic, tachypenic, and had rapid respirations (38 per minute) and labored breathing. She was placed on 100% oxygen non rebreather mask. Upon arrival to the ER she was alert but poorly responsive. The pt did not follow verbal commands. Blood pressure 141/78, pulse 111 and regular. Respirations were 24 per minute and temp was 100.3. Oxygen saturation 98% on 15 liters oxygen per non rebreather mask which was changed to nasal cannula at 4 liters per minute. Oxygen saturation maintained at 92-93%. Lab findings included a chest x-ray with right lung infiltrate and a CT scan which was unremarkable for pt age but showed small vessel disease. Her platelet count was 138 which was slight low. (see lab/diagnostic tests for additional exam findings). The pt was diagnosed with aspiration pneumonia and presumed chronic obstructive pulmonary disease with carbon dioxide retention. Treatment was started with intravenous antibiotics with almost complete resolution of the infiltrate and gentle intravenous hydration. Although significantly improved on treatment, the pt could not be weaned off of the oxygen and in fact had prolonged periods of unresponsiveness. The pt's daughter reported to the physician that the pt does have these episodes from before which was most likely caused by her mental disease. The daughter wanted the pt kept comfortable. The pt was discharged on 07Apr05 on cefuroxime axetil (Ceftin 500mg bid for 2 additional days, clindamycin 150mg tid for 2 weeks, diltiazem hydrochloride (Cardizem cd) 100mg daily, prednisone 10 mg with a tapering dose and oxygen 2 liters per nasal cannula. It was noted that the pt had fully recovered from the aspiration pneumonia and that it was not thought that the aspiration pneumonia was related in any way to the pneumococcal 23v polysaccharide vaccine. Additional information not available.  A  copy of the medical record was provided as further documentation of the pt's experiences.