Age: 56.0
Sex: F
Vaccine: PPV
Symptoms: Injection site warmth, Neuropathy peripheral, Pyrexia
Clinical narrative: Info has been received from a physician with hay fever, allergies (described as "very allergic history"), allergic to penicillin, cepalosporine, multiple food allergies and "a variety of inhaled toxins such as cat hair, dog hair, etc." It was also noted that she had a hive reaction to Maryland blue crabs. The physician on 05/04/2002 (previously reported as 05/02/2002) at approx 1:00 PM was vaccinated with a 1st dose of pneumococcal vaccine 23 polyvalent (lot #640578/0996L), intramuscularly in the left arm. Concomitant therapy included hormone replacement therapy. It was noted that the pt had taken "7 or 8 years of allergy injections as a child." Within 2 hours post-vaccination, she experienced peripheral neuropathy. Within 3 to 4 hours post-vaccination, the pt developed fever, chills, fatigue and weakness. It was reported that at approx 4:00 PM, 3 hours after vaccination, the physician developed diaphoresis and perfuse sweating, especially of the face, neck and the upper trunk. The physician reportedly thought that she had "missed her hormone replacement therapy and took a second one thinking that this was an unusual 'hot flash'." After taking the second dose of hormone replacement, she "actually felt worse." The physician reportedly "could barely pick up a small suitcase," "could not sit up," and later "could not hold up (her) head." By 2:00 AM she was reportedly so physically exhausted that walking a distance was reportedly a "major challenge." At approx 6:00 AM she "could not even eat" and "could barely hold up the cup of coffee." Later that afternoon, her left arm, at the injection site, got hot, swollen, and extremely heavy in sensation "as if it weighed 50 or 60 pounds." The physician reportedly could not even lift her arm. She had no problem elevating her index finger and her thumb although she thought her hand was paralyzed. It was reportedly only her fifth finger that was markedly affected, the fourth and the third probably less so, and the second and first not at all. The physician felt that she could not lift her right arm, however she was able to without any problem. She reportedly could not move her left arm up. Within 4 hours, she developed sweating, very warm, hot heavy feeling in both arms, exhausted and state of ataxia. The physician notice that her gait was "quite ataxic." She had a feeling of "walking on jelly with rubber legs." She described her gait as a "very broad-based gait" and she also had the sensation that her "legs were going to buckle at any time." At 5:00 PM she was reportedly still in bed. The physician reportedly "had not left the bed except to go to the bathroom on one occasion." By that time the warmth and heaviness of the left arm had subsided. She had  "slept most of the afternoon." When she woke up, she could elevate her arm where she did not think she could earlier. The physician could move her fingers without any problem at all by 5:00 PM. The physician reported that she was "almost 100% by about 10 o'clock at night." The physician reported that this was approximately 29 hours after the injection at 1:00 PM the day before. She reportedly slept well that night. The next day she felt like a "new woman with a new lease on life." The physician felt at one time that she was getting Guillain-Barre syndrome and wanted to report her experience as a probable peripheral neuropathy reaction to the pneumococcal vaccine 23 polyvalent. The physician reported that she "will never have another (pneumococcal vaccine 23 polyvalent)" and stated that "the symptoms were fairly dramatic and fortunately lasted only a total of 29 hours from the time of injection" and "had 100% resolution of symptoms with no treatment at all." The physician noted that she had flu vaccinations in the past. After he first flu vaccination in 1995, she developed a local reaction and some minor flu-like sensations lasting no longer than 24 hours, all very mild. The physician had subsequent flu vaccinations without any sequelae. No further info is expected.