Age: 1.1
Sex: F
Vaccine: FLU3, FLU3
Symptoms: Rash macular, Viral infection, White blood cell count decreased
Clinical narrative: December 16, 2005 - A cath UA that was negative.  Culture negative, blood culture negative, CDC - white count 10.6, hemoglobin 12.3 A 13 month female patient with no significant medical history, had received her first administration of FLUZONE SV '2005-"2006 USPC, lot number U1814AA (route and site not reported); an administration of another manufacturer's MEASLES, MUMPS, AND RUBELLA VACCINE, lot number 0578 R (route and site not reported); and an administration of another manufacturer's VARIVAX vaccine, lot number 0625R (route and site not reported) on 10/Nov/2005.  Approximately tow days later, she developed loose stools.  She was afebrile.  The patient subsequently received another administration of FLUZONE SV'2005-'2006' USPC, lot number U1761AA (route and site not reported) on 14/Dec/2005.  The patient had not recovered from this event at the time of this report.  The patient had received Tylenol shortly before presenting to the clinic and at that time her temperature was 103.8.  On exam she was slightly listless, apathetic with no respiratory distress.  Heart was tachy, other wise regular rhythm, no murmur.   Lab tests performed on 16/Dec 2005 showed a cath UA that was negative.  CBC - white count 10.6, hemoglobin 12.3, hematocrit 35.9, platelets, 274,000.  Differential 14% bands, 56% segs, 2% eosinophils, 10% monocytes, and 8% lymphocytes.  The patient was given 500 IM Rocephin prior to dismissal and asked to follow-up the next day with a repeat CBC. On 17/Dec/2005 the patient was seen again.  She was given Tylenol and the temperature did initially decrease but then spiked up to 104.9 twice over the following 24 hours.  Her maximum temp since receiving Rocephin has been 102.8.  Mom states that her daughter has had increasing irritability over the past eight hours, but is drinking better.  She was given Motrin, last does at 04:00.  She has not had  any vomiting or diarrhea.  Good urine output.  No other family members have been ill.  Mother stated that the day prior after her daughter was given Motrin she did stand up but had a hard time walking.  She has not observed any seizure activity or focal neurologic symptoms.  NO skin rashes noted.  No meningeal signs demonstrated.  Oxygen saturation 97% on room air with a heart rate of 140, BP 82/56.  On 17/DEc/2005 CRP was 2.5.  White count was 2500 with 42% lymphocytes, 36% segs, and 14% bands.  There were a few lymphocyte variants present.  Platelet count was stable at 225.  Hemoglobin was 10.4 grams, SGPT was nomal, SGOT elevated a t75.  Blood and urine cultures negative after 14 hours.  Ibuprofen will be continued and encouraged fluids.  Rocephin 500 mg IM with the throat cultures negative for 28 hours. On 19/Dec/2005 the physicians spoke with the mom.  Her daughter's fever subsided yesterday.  She did break out in a red macular rash with did blanche.  She is very alert and playful today.  Appetite is stable.  Per reporter, the working diagnosis therefore is systemic viral infection with viral exanthema versus vaccine induced fever and rash.  Given the fact that the patient had a similar response after the first flu shot, it was recommended to withhold further flu vaccinations at this time.  ON 21/Mar/2006 the reporting physician called Sanofi Pasteur and reported the patient recovered.  Date of recovery not reported.  No further information expected.  The reporter for this case is the same as for case 2005-02803.  Follow-up information received on 21/Mar/2006 On 10/Nov/20005, the patient received the intramuscular injection of Fluzone (dose one) lot number U1814AA in the left thigh and the injections of Measles, Mumps, and Rubella (dose one), manufacturer Merck, lot number 0578R in the right thigh, and Varivax (dose one), manufacturer MERCK,  lot number 0625R in the left thigh.  Following these immunizations, the patient had a low-grade fever for about five days.  No other symptoms were reported.  The patient received the second dose of Fluzone, lot number U1761AA on 1/Dec/2005 which was administered intramuscularly int he right thigh.  Mom reported that approximately three hours later her daughter developed a temperature up to 104 (rectal) and was quite irritable.  She was seen by a physician on 16/Dec/2005.  The