Age: 61.0
Sex: M
Vaccine: PPV, PPV
Symptoms: Cellulitis, Injection site erythema, Injection site oedema
Clinical narrative: Information has been received from a physician concerning a 61 year old male patient with obesity (BMI = 39), hypertension, sleep apnea and severe degenerative joint disease of his knee with one total knee replacement who on 5/30/03 was vaccinated in the right deltoid with a dose of pneumococcal vaccine 23 polyvalent. The reporter noted that the vaccine was administered as a routine immunization for protection from invasive pneumonia, although the patient was somewhat reluctant to take it. In the evening of 5/30/03, the patient developed a fever, myalgias, arthralgias, and night sweats. The next day, the patient went to the urgent care center and was noted to have a small local area of erythema and tenderness. The patient was given cephalexin and was told to return if it got worse. That night, the patient had more fever, myalgias, arthralgias and the area of erythema and tenderness grew in size. The following day, the patient returned to the urgent care center and was treated with IV antibiotics and was told to return the next day for another IV treatment. On 6/2/03, there was some improvement. The orthopedist saw him that day and was alarmed and warned him to come immediately to the hospital if he had any pain or swelling in the right knee. On 6/3/03, the patient was seen by the reporting physician. The patient did not look toxic. The patient's temperature was 97.1 and his pulse was 66. The patient's skin had not petechiae, rash or splinter hemorrhages. There was an irregular area of erythema, swelling and tenderness over the right deltoid, but the pattern was not typical for a local cellulitis. There were no nodes in the axilla, supraclavicular or post cervical areas or in the groin. The posterior pharynx was clear. The chest was clear to auscultation. The heart revealed normal sinus rhythm, no murmurs or gallops in supine and left lateral decubitus position. The abdomen was not distended and there was no liver or spleen enlargement. The right knee showed no swelling, erythema, or tenderness. The left knee was also unremarkable. The extremities showed no edema. The patient continued to improve with a decrease in the swelling in his arm and a lessening of his arthralgias and myalgias. On 6/10/03, the patient had recurrence of his fever and he developed diarrhea. The reporting physician saw the patient the next day. The exam was unremarkable. The patient's temperature was normal and the swelling in his right arm had decreased markedly. There was no erythema. Because the patient had finished his antibiotics a few days before, three blood cultures were ordered and have remained negative. Creatinine and electrolytes were unremarkable. A CBC was not done, but a sedimentation rate was 35. The patient was scheduled to see the reporting physician again one week later, and he was also scheduled to see an infectious disease specialist in early July 2003. The reporter considered the patient's experience to be serious reaction. Upon internal review, the patient's experience was considered to be an other important medical event (OMIC). Additional information has been requested. A 15-day follow report received 9/5/2003 adds: Additional info is not expected.