Age: 53.0
Sex: F
Vaccine: PPV, PPV
Symptoms: Face oedema, Hypersensitivity, Laboratory test abnormal, Rash, Upper respiratory tract infection
Clinical narrative: Information has been received from a physician concerning a 53 year old white female with a long standing history of bronchial asthma and a history of colitis seven years, impending cholecystectomy, osteoarthritis, degenerative and possibly torn disk of the lower spine, hypertension, and gastroesophageal reflux disease, who was vaccinated in the deltoid on 30Sep03 (also reported as 30Sep04) with a first dose of pneumococcal 23v polysaccharide vaccine. Subsequently the pt experienced an anaphylactic reaction. The physician indicated that the pt was referred to her as a second opinion, and the physician had not yet seen the pt. She did not have specific information, but she believed that the pt was hospitalized and that the vaccine was given within the last few months. An allergist did a skin test, and the results were positive for an allergy using Pneumovax. No additional information was available at the time of the report. Unspecified medical attention was sought. There was no product quality complaint. Follow up information received from a physician indicated that the pt left the office within minutes of vaccination, and while grocery shopping across the street from the medical facility at 8:50AM, the pt began to develop stomach pains at about 20 minutes  following the injection. While awaiting her turn in the bathroom, she noted her face was brightly red with a rash like appearance. She then began to note swelling about the lips with difficulty swallowing and recognized this might be an allergic reaction. She drove herself across the street to the medical facility and approximately a half hour  after her injection was treated there with a dose of epinephrine. She was then transferred by EMS to the hospital, where she was observed for several hours without further treatment. She was discharged on albuterol and prednisone and diphenhydramine. She did not have further reaction and thought that the reaction was actually subsiding by the time she arrived at the ER. She had also felt that even prior to the epinephrine being administered the symptoms were possibly abating. There was no local reaction noted at the injection site. She continued the albuterol, prednisone, and diphenhydramine as instructed through 03OCt03 (also reported as 03Oct04). The week following the reaction on 06Oct04 (also reported as 08Oct03), the physician saw her and put her on several additional days of prednisone because of increased asthma symptoms. She had had a third course of prednisone the second week of December because of continuing allergy symptoms, and in late December an upper respiratory infection necessitated treatment with antibiotics. On the day of her reaction, she had minimal foods. The pt drinks Tab regularly. She had no change in her medication in the days preceding. She had started celecoxib (Celebrex) two months earlier. There have been no lapses in any of her medications including her mesalamine (Asacol), her celecoxib (Celebrex), and her daily aspirin. The had adjusted her estrogens, conjugated (Premarin) dosage downward from double to 0.625 single tablet in early September. No other changes or exposures were noted. No other history of anaphylaxis to foods or medications were noted, and the pt has previously tolerated all vaccines without difficulty. The pt can eat gelatin without problem. She had never received  a hepatitis series. On 02Dec03, she was tested with full strength pneumococcal vaccine with negative testing. She had subsequently been administered influenza vaccine on 15Dec03 following initial negative testing without difficulty. She had other allergy testing at that time as well. She has tolerated surgeries without event and has not been aware of any latex hypersensitivity. Her usual peak flow range is 400. It was noted that the pt has had constant year round rhinorrhea for many years. She recalled early childhood symptoms of allergic rhinitis, long known to have cat and dust allergen hypersensitivity. At the age of 35, following what was believed to be a mycoplasma pneumonia for which she was hospitalized, she began to have reactive airways and initially was having problems with exercise induced asthma that progressed to more steady asthma problems. Over the years, she has been treated with inhaled corticosteroids and multiple courses of oral corticosteroids. In the past, she has recalled treatment with triamcinolone acetonide (Azmacort), then more recently fluticasone propionate (Flovent), and now over the last three years has alternated between fluticasone propionate (+) salmeterol xinafoate (Advair) prescription 500/50 and 250/50 strength. She has still found the need for pre-medication with albuterol prior to exercise. She monitors peak flow. She had been using montelukast sodium (MSD) on a daily basis. The pt has been on aspirin preparations for several years without obvious adverse effect on asthma. She has also been on mesalamine (Asacol) for colitis without effect on asthma noted. She has undergone allergy testing on 02Dec03, demonstrating positive reactions toward dust mite species Farinae, Pteronyssinus, cat, dog, grass, ragweed, Alternaria. No reactions found to molds Hormodendrum, Penicillin, Aspergillus, belminthosporium, Fusarium, Rhizopus, Chaetomium, Mucor, Epicoccum, oak, birch, maple. At age 50, the pt had a contact dermatitis develop to poison ivy and has had several episodes annually. There is no history of hiving or urtication. No history of dermatographism. There is a remote history of welting developing when she found sensitivity to some of the inks on newspaper print. No history of Jell-O or gelatin reactions. She has eaten recently without problems. The plan indicated that although it seems unlikely that she should react to other vaccines with different components and different excipients, it would be advisable to follow the physician's protocol to either skin test or provided a small one tenth or lower dose initially, followed by observed administration and observation for 1/2 to 1 hour following vaccine administration with subsequent vaccines. The pt notably has tolerated influenza vaccine administration and should not require this protocol for influenza vaccine. It was noted that the pt should not have further administration of pneumococcal 23v polysaccharide vaccine. Follow up information was received which pertained to events that occurred after vaccination with pneumococcal 23v polysaccharide vaccine. This information contained the following adverse experiences: worsening asthma (08Oct03); upper respiratory infection (30Dec03). No further information is expected.