Age: 6.0
Sex: M
Vaccine: VARCEL
Symptoms: Skin ulcer, Viral infection
Clinical narrative: Information has been received from a physician concerning a 13 year old male who in approximately 1996, at the age of 5 years, was vaccinated with a dose of varicella virus vaccine live. On 24-Feb-2004 it was reported that the patient "recently" developed a case of full blown chicken pox. The number of lesions was not provided. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.   This is in follow up to report previously submitted on 05/14/2004, information has been received from office staff concerning a 13 year old male with no relevant medical history, no known allergies. Other immunization up to date, no previous hospitalizations or surgeries and no known family history of exposures to chickenpox or current illness who on Apr 3 1996, at 5 years of age, was vaccinated at 14:00 with a first IM dose of varicella virus vaccine live (lot 608578/0389B). There was no illness at the time of vaccination. The patient developed a rash which began on 11/26/2003 (also reported a 11/30/2003). He was seen in the ER on 11/29/2003 with a normal CBC and a negative mono. The patient was then seen by a physician on 12/01/2003 and was thought to have varicella (previously reported as a case of full blown chicken pox)  One lesion appeared to be secondarily infected. The patient was started on Cephalexin (Keflex) PO. Since the visit, the rash had progressed and the patient complained of being short of breath. He denied vomiting, diarrhea, or fever with this current illness and had been eating relatively well. He was admitted to the hospital on Dec 9 2003, for a duration of 4 days (also reported as 48 hours and 2 days), with a severe progression of the rash ( also reported as severe varicella) and possibility of a varicella pneumonia. Upon physical exam, it was noted that the patient was alert, nontoxic, neurologically intact with pupils equal and reactive to light bilaterally and in no acute distress, however very anxious. His temperature was 97.7 pulse oximetry was 98%, respiratory rate was 30 and heart rate was 100. His sympanic membranes were clear. His pharynx was significant for varicella lesions in the upper left molar region and also on retractions. A cardiovascular assessment revealed a regular rate and rhythm without murmur. His abdomen was soft and nontender without mass or hepatosplenomegaly. A genitourinary assessment revealed a normal male with varicella lesions on his penis and scrotal area. His skin was significant for multiple crusting and vesicular lesions all over his trunk and back with greater than three or four lesions per square inch, especially on his trunk or back. The number of lesions was not provided. During the hospital treatment course, the patient was admitted to a pediatric floor and placed on IV fluids. Lab studies obtained were a CBC and a complete metabolic panel which were normal (see blow for specific values). A chest X ray was negative and his oxygen saturation was good. He was started on IV Acyclovir and IV nafcillin and was given hydroxyzine 25 mg PO Q 6 hours for the itching. He has had no fever sicne hospitalization. It was noted that the patient continued to have some new vesicular lesions with new crusting of the old vesicular lesions. It was also noted that he did well throughout the 48 hours of admission with no respiratory distress and a stable blood pressure. The patient was discharged on 12/11/2003. The discharge diagnosis was severe vericella, varicella penumonia ruled out. Discharge medications included acyclovir 800 mg QID, cephalexin (Keflex) 500 mg TID, and hydroxyzine 25 mg Q 6 hours. The patient was to follow up in seven days. No product quality complaint was involved. Follow up information revealed that the patient had recovered from the varicella in Jan 2004 and was doing well. It was noted that the patient had residual scars from the varicella lesions. No further information is requested.