Age: 44.0
Sex: F
Vaccine: MMR
Symptoms: Pyrexia, Rash, Urticaria
Clinical narrative: Initial and follow-up info has been received from a registered nurse and a physician concerning a 44-year-old white female, "new hire", with penicillin allergy, who was "rubella negative and rubeola positive". On 04/05/2002, the pt was vaccinated SC with a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (Lot #640562/1374L). On 04/23/2002 the pt notified the Employee Health department that she experienced joint pain, stiff neck and developed hives, fever and a rash. She asked about "side-effects" of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) and was told that employee health professionals "have seen this reaction recently" and that it should subside. She was instructed to return to Employee Health dept if the symptoms worsened. The rash was first noted a few days post-vaccination and was described as a facial rash, along the jaw. On approx 04/19/2003 (reported on 04/26/2002 as "later last week"), the hives were noted over her lower back and buttocks. At that time, she also had a swollen right knee with fluid. On approx 04/23/2003, she began to develop stiff neck, chills, aching and feeling tired. On 04/25/2002 the Pt called the Employee Health dept and reported that she felt worse and missed 2 days of work. She was reported to have the same symptoms, described as "flu-like". It was reported that she also had a fever, but did not have a thermometer. The pt was treated with acetaminophen (TYLENOL) and diphenhydramine (BENADRYL). On 04/26/2003 she was seen in the Employee Health dept. She "says (she) feels better today" was documented. Her vital signs were reported as temperature 97.1 degrees F, pulse 72 and blood pressure 124/88. She was in no distress. It was noted that she denied rash or joint pain, and the swelling marks on the left buccal mucosa "as a habit". It was specifically noted that her knee exam was normal, with no joint pain or effusion. There was no rash present on her face or back. Subsequently, all symptoms had resolved. It was noted that the pt admitted to many stressors "recently", including a new job, software, and "child to college". The physician discussed the "remote possibilities" of this being a reaction and that if it was a "rubella vaccine strain case", it should resolve in several weeks. It was also noted that there was a chance that this was an unrelated viral infection and that many in the community had the same symptoms "at present". Her prognosis was reported as "good" and the physician indicated that he would follow closely. The pt was noted to be comfortable with this and very pleasant and understanding. As of 04/26/2002, she had incurred no costs and had used paid time off for days she missed from work. On 04/26/2002, she was working. The physician indicated that he would see her the following Tuesday (04/30/2002), "next day open", and that he "might close by phone, if well, no findings on exam today". Additional follow-up indicated that the pt returned for follow-up, on 04/30/2003, and was "much better". It was also reported that the pt developed a generalized illness, with aching and chills, following vaccination with hepatitis B vaccine recombinant (yeast) (manufacturer unknown) (WAES #0207USA02551). Additional info has been requested.