Age: 1.05
Sex: M
Vaccine: HBHEPB, MMR
Symptoms: Asthenia, Cough, Decreased appetite, Erythema, Irritability
Clinical narrative: Information has been received from a nurse practitioner concerning a 12-month-old Hispanic male with no known drug allergies or medical conditions who on 11-OCT-2005 was  vaccinated at another clinic with an IM first dose in the left thigh of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live.  Concomitant vaccine that day included a dose of hepatitis B virus vaccine rHBsAg (yeast) (+) HiB conj vaccine (OMPC) (MSD) (lot6497361156N).  There was no illness at the time of vaccination.  It was noted that three days ago (19-OCT-2005) the patient experienced signs and symptoms of fever, rash and pustules on his face, trunk and limbs.  The reporter mentioned it is thought that the patient has measles.  The patient is still being treated with oral and dermal steroids/prednisone, Aveeno bath, and oral analgesics.  A complete blood count (CBC) is being completed to confirm measles.  The symptoms are persisting.  No other information was available regarding the adverse event or the patient's outcome.  Follow-up information from a nurse practitioner and medical records indicted that the patient was vaccinated on 10-OCT-2005.  On 14-OCT-2005 the patient was seen by the physician with a chief complaint of fever and vomiting.  The patient looked weak, was irritable and was not eating well.  Assessment was an upper respiratory infection.  The patient was seen on 17-OCT-2005 and the upper respiratory infection was resolving.  On 22-OCT-2005 the patient was seen with complaints of a rash.  The child had a rash for 2 days.  It started on the face on 21-Oct-2005 and spread to her entire body.  She also had rhinorrhea, a dry cough, mild fever and pruritis.  It was noted that upon exam she had erythematous papular rash on the face with discrete papules on the arms and legs.  Pharynx had no lesions and there was clear rhinorrhea.  Assessment was suspected measles and supportive measles care was advised.  A blood culture drawn on 22-OCT-2005 was negative at 48 hours.  On 24-OCT-2005 the patient had a rapid strep test which was negative, an IGM was negative (" antibody not detected"), and rubeola AB IGM was positive at 4.53.  The patient was seen for follow up on the rash.  It was noted that the rash was more likely a reaction to the vaccine than actual measles.  The plan was to continue to monitor the child and make sure a measles IgM was drawn.  It was noted that the office was unsure if vaccines with same lot number should be set aside and they wanted to hold this lot of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot6492320028R).  Other vaccination history included a first (lotX1060AP). SECOND (X1040AP) and third (Y0324AP) dose of poliovirus vaccine on 10-NOV-2004, 09-FEB-2005 and 03-AUG-2005 respectively, a first,(U1343BAAP) second (U13434AAP) and third (AC14AD11APAP) dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid on 10-NOV-2004, 09-FEB-2005 and 03-AUG-2005 respectively, a first (lot6488090145P) and second (lot6492890901P) dose of hepatitis B virus vaccine rHBsAg (yeast) (+) Hib conj vaccine (OMPC) (MSD) on 10-NOV-2004 and 09-FEB-2005, a first dose of varicella virus vaccine live (lot6497360018R) on 11-DEC-2005 and a first (A95722), second (A74405E), third (A944566) and fourth (A56117E) dose of pneumococcal 23v polysaccharide vaccine (PNUIMMUNE) on 10-NOV-2004, 09-FEB-2005, 22-AUG-2005 and 07-NOV-2005 respectively.  The records of testing prior to release of this lot have been checked and found to be satisfactory.  The lot complies with the standards and was released.  No additional information was provided.