Age: 51.0
Sex: M
Vaccine: TDAP
Symptoms: Blood cholesterol normal, Blood triglycerides increased, Condition aggravated, Dermatitis, Differential white blood cell count
Clinical narrative: Reason for Visit: Dr. consults at 4:20 on Thursday (20SEP12) re: 51 y/o health male, who Dr. just finished seeing as patient at Clinic with a generalized skin eruption, onset 2-days s/p receipt of Tdap on (22AUG12), with no associated systemic sx. Today is day # 29 s/p patient's receipt of Tdap and Dr. states that patient's rash is almost resolved at this point, but she would like to Inquire if such rash are frequently associated with receipt of Tdap vaccine? Dr. Inquires opinion if patient's rash could possibly represent a generalized drug eruption r/t to patient's receipt of the Tdap vaccine on 22AUG12 vs. a Spongiotic Dermatitis? NP explains that Tdap vaccine is most commonly associated with local reactions at the injection site, not generalized rashes. NP contacts Medical Director, who returns call to Dr. on Friday morning(21SEP12) to further answer her questions re possible vaccine causality of patient's rash. HPI: Tdap was administered on22AUG12 at employee's annual fitness exam. He did not receive any other vaccines at that time. Patient denies any prior viral or GI illness within a 30-day window PRIOR to receipt of Tdap on 22AUG12. Review of patient's Vaccine History, documents that patient received a dose of DTaP on 25AUG12, when he started working as a Security Guard. The documents of DTaP vs. Tdap on 25AUG10, most likely represents a transcription error, as DTaP is only indicated for Pediatric use (2 months to 6 yrs of age), whereas, Tdap is the ADULT version of the vaccine indicated for ages 11-64 yrs and was, most likely, the vaccine administered, but mistakenly documented as DTaP. The issue at hand, however, is that the patient received 2 doses of Tetanus Toxoid/ Diphtheria Toxoid /Acellular Pertussis vaccine(s) within a 2-year interval, when only 1 dose of Tdap is recommended by the ACIP for all adults 18 yrs and older. The patient is not due for another Td booster for another 10 years. About 24-36 hours after receipt of the Tdap (22AUG12), the patient noticed a lot of tiny red bumps on his forearms, which spread to his upper arms, chest, abdomen, back, flank and legs over the next 3-4 days. The rash was mildly pruritic. He was seen at Clinic on 27AUG12 by PA-C, who treated the patient's generalized rash with a Prednisone 10mg dosepak and ATARAX 1-2 tabs q8h prn pruritus. She also treated a localized rash on the back of pt's left ankle (present > 2 months) with topical BACTROBAN 2% topical ointment tid (SEE photos in Note, 27AUG12). Provider instructed patient to f/u if generalized rash had not resolved after completing the 6-day Prednisone dosepak. Pt attempted to reschedule a f/u appt on 11SEP12, but Provider had deployed. Pt was instructed to reschedule a Primary Care appt with another Provider at Clinic. He called Clinic on 14SEP12 and spoke with the Advice Nurse, who advised patient to take OTC BENADRYL & soak in Oatmeal Aveeno baths for itching, as no appts were available till 09OCT12. So, he went to Patient Advocacy Dept and they they helped him to schedule a f/u appt sooner (See 17SEP12) with Provider: for "skin rash to entire body > 2 weeks." Patient requested the Provider for DERM referral for his history of psoriasis (left knee), which had flared to his right knee, after completing the 6-day prednisone dosepak.