Age: 11.0
Sex: F
Vaccine: PPV
Symptoms: Body temperature increased, C-reactive protein increased, Condition aggravated, Cyanosis, Cyclic citrullinated peptide A increased
Clinical narrative: Information has been received from a health authority concerning an approximately 11 year old female, healthy and normal, with no allergies reported, takes no regular medication, and a history of migraine (2005), otitis, sinusitis, urinary tract infection, colpitis, large adenoid, immunisation and immunological complement abnormal. Family history includes her father with an allergy to plants and infectious asthma, an uncle and grandmother with migraines. Patient history according to pediatrician 27-JUN-2008 and 11-JUL-2008: This 11 year and 4 months old girl, (3rd child of 3 children in the family) who has had a normal childhood and got normal vaccines. She has no allergies and until preschool age (6 years) she has been quite healthy and has been in home care. as a child the patient has had some otitis but during the last years she has not had any more suffered from those. During the last two years she has been suffering from re-occurring sinusitis which she has had about 3 times in spring times and 3 times in autumns. Diagnosis had been made based on symptoms and ultrasonic examination. She does not usually have fever with sinusitis. According to the patient's mother she had about 10 antibiotic treatments for sinusitis infections annually. Also according to the mother, the patient had suffered from several (around 20) otitis which have been treated by antibiotics.  Since the spring of 2008 the patient has had 4 antibiotic treatments for sinusitis spring 2008 the patient had otitis. The patient's history does not include any pneumonias. Since the patient was 2 years old she had several urinary tract infections. Nowadays she has urinary tract infection about once a year. Most probably infections. On 06-JUN-2008 x-ray pictures for nose and maxillary sinuses was clear. A large adenoid was diagnosed on 06-JUN-2008 and a discussion of removing it was held with the patient. NASONEX spray for nose was started to prevent sinusitis. Allergy tests have been made on 11-JUL-2008 (prick-test) and patient was not allergic for most of the common allergens. On 27-JUN-2008 the pediatrician investigated the blood examination, total hemolytic compliment, immunoglobulines, Alfa-1 Antitrypsin and phadiatop it was found out that activity of the immunological complement of the patient was abnormal. The function of lectins was missing. Because of the lack in immunological mechanism, the pediatrician wanted to investigate the response for pneumococcal vaccine. On 15-JUL-2008 the patient was vaccinated intramuscularly into the left arm with a first dose of PNEUMOVAX 23 (Lot # 657144/1458F; batch #NG12950), to investigate the immunological response of the vaccine as requested by her pediatrician. Immediately after the vaccination the patient began to turn white and then her lips began to turn blue. The patient became slightly indisposed. The symptoms did not become worse and the patient was discharged to home after the vaccination on 15-JUL-2008. In night of 15-JUL-2008 about 20:00 the patient developed fever up to 39 C and developed a large erythematic, swollen and painful area (largeness reported 6-7 cm on summary template and 7-8 cm by pediatric in hospital records) to the upper left arm and moving of the left arm caused pain. She also developed a strong beating headache beginning on 15-JUL-2008 and neck pain and she also vomited once (on 16-JUL-2008 according to summary template and on 17-JUL-2008 according to hospital records of patient). The patient came to the hospital on 18-JUL-2008 with using sun glasses because her eyes were irritated by the light. All symptoms were continuing when the patient was hospitalized on 18-JUL-2008. At the time of hospitalization the patient weighed 41.7 kg, her temperature was 37.3 C, blood pressure was 111/76 and heart beat 97. Cefuroxim (manufacturer unknown) was begun to administer intravenously. The CRP was examined to be 1589 and leukocytes 14.5. An ultrasound of the arm was performed to exclude abscess while a large subcutaneous edema was diagnosed. The local reaction in the upper left arm begin to become small with the treatment and the patient was discharged home in good condition on 19-JUL-2008. Amoxicillin treatment per oral was given the patient to continue at home for a week. Complication after pneumococcal reaction was diagnosed by the physician. The patient had fever for four days for the rest of the reactions outcomes are not reported. On 19-SEP-2008 pediatrician called the patient to inform that the response for PNEUMOVAX has been good. During the autumn 2008 the patient has had one sinusitis and one otitis. Other business partner numbers include: E200810491 and FINAM20081169. No further information is available. This case is closed.