Age: 3.0
Sex: M
Vaccine: FLU(H1N1)
Symptoms: Lip swelling, Nuclear magnetic resonance imaging, Pyelonephritis acute, Pyrexia, Rash
Clinical narrative: Please note his regular medications and schedules are as follows:  Keppra (Levetriacetam 750 mg tab):      375 mg (1/2 of 750 mg tab) in the morning between 700am-730am      375 mg (1/2 of 750 mg tab) in the evening between 600pm-630pm  Lamictal (Lamotrigine 150 mg tab):      75 mg (1/2 of 150mg tab) in the morning between 700pm-730am      75 mg (1/2 of 150mg tab) in the evening between 700pm-730pm  Klonopin (.5 mg tab)-  .25mg (1/2 of .50 tab) in the morning between 700am-730am     .25mg (1/2 of .50 tab) at lunch between 1200pm-100pm     .25mg (1/2 of .50 tab) in the evening between 700pm-730pm  Symptoms after received H1N1 Vaccine Shot: 1.  day 1 (Thursday 11/12/2009): evening within 10 minutes of h1n1 vaccine shot started with runny nose and constant wiping/swiping nose/cheeks and later ears, fussy. Regular meds as listed above. 2.  day 2-3 (Friday 11/13/2009 & Saturday 11/14/2009): still swiping/wiping nose/face/cheeks/ears, light runny nose, start of rash on cheeks. 11/14/2009- gave zyrtec and regular meds as listed above. 3.  day 4 (Sunday 11/15/2009): start of nasty red rash across/on both cheeks, also across bridge of nose, and upper lip starting to swell and getting chapped. 11/15/2009 gave zyrtec/1.5% hydrocortisone cream/neosporin with antibiotic, and chapstick on lips, along with regular meds as listed above. 4. day 5 (Monday 11/16/2009): cheeks very bright red (circular) rash, some rash across nose bridge (not as red as before), upper lip more swollen, cracked, and bleeding some, and he was still swiping and wiping nose/cheeks and face. Received call from day care about rash on face, and swollen/ cracked and slight bleeding lips. 11/16/2009 gave zyrtec/1.5%hydrocortisone cream/neosporin with antibiotic, and chapstick on lips, along with regular meds as listed above.  5.  day 6 (Tuesday 11/17/2009) cheeks still very bright red (circular)rash, some rash across nose bridge (not as red as before), upper lip more swollen, cracked, and bleeding some, and he was still swiping and wiping nose/cheeks and face. 11/17/2009 gave zyrtec/1.5%hydrocortisone cream/neosporin with antibiotic, and chapstick on lips, along with regular meds as listed above. 6.  day 7 (Wednesday 11/18/2009) redness on cheeks diminishes somewhat to lighter pink (not as red), rash on bridge of nose almost goes away, lips still swollen/chapped/cracked with  some bleeding. 11/18/2009 gave zyrtec/1.5%hydrocortisone cream/neosporin with antibiotic, and chapstick on lips, along with regular meds as listed above. 7.  day 8 (Thursday 11/19/2009) cheeks again started very bright red (circular) rash, some rash across nose bridge (slight/patchy pink), upper lip still very swollen, cracked, and bleeding some, and he was still swiping and wiping nose/cheeks and face. 11/19/2009 gave zyrtec/1.5%hydrocortisone cream/neosporin with antibiotic, and vaseline on lips, along with regular meds as listed above.  I  called the pediatrician's  office and asked to be seen.  An appointment was scheduled for Friday, November 20, 2009, at 245pm. 8.  day 9 (Friday 11/20/2009): redness on cheeks diminishes somewhat again to lighter pink (not as red), rash on bridge of nose even lighter than before and almost goes away, lips still swollen/chapped/cracked with some bleeding. Went to appointment with pediatrician, and discussed my concerns about symptoms after receiving h1n1 vaccine shot at health department 11/12/2009.  I explained  the runny nose/rashes/swollen/cracked bloody lips.  He had no fever and since rash was diminished again (I explained this happened a couple of days before and came back), he said to watch him and call him if it start back.  11/20/2009 gave zyrtec/1.5%hydrocortisone cream, and vaseline on lips, along with regular meds as listed above. 9.  day 10 through day 11 (Saturday 11/21/2009 through Sunday 11/22/2009): rash back again on both cheeks (started to get redder as day went on), to a bright red (circular) rash, rash across nose went away, upper lip still very swollen, cracked, and bleeding some, and he was still swiping and wiping nose/cheeks and face.  Still fussy, not wanting to eat or drink much fluids.  Late afternoon around 430pm, noticed he was hot to the touch, lethargic, and after checking temperature, it read 103.9 degrees.  11/21/2009- Immediately took him up to the bath tub for a tepid bath (to cool him down), started him on children's motrin (every 8 hrs)/feverall suppositories (every 4 hours).  Also, gave zyrtec/1.5% hydrocortisone cream/neosporin with antibiotic, and vaseline on lips, along with regular meds as listed above.  Contacted my mother (retired Registered Nurse- after 38 years and her previous employment was as Director/Head Nurse)- she said to continue what I was doing and if his temperature does not go down to call urgent care.  His fever went down to 101 degrees and throughout the night went up to 102.1 and back down to 100.9 to 101 range (around 8:00 am, Sunday, 11/22/2009).  Sunday 11/22/2009, between 8:00 am and 11:00 am: Did not eat much or drink much fluids, but normal urine output.  Around 11:00am, I noticed he was getting lethargic again and checked his temperature, which read 105.3 degrees. I immediately called urgent care and while waiting for the on-call nurse to call back, I rushed him to the bathtub for a tepid bath and gave another feverall suppository and a dose of children's motrin. The urgent care nurse called back and explained his fever had increased and that he had increase of seizures, along with the range of symptoms he had since receiving the H1N1 vaccine and that he had a seizure disorder.  She spoke with one of the on-call urgent care doctors and they said instead of bringing him to urgent care, go ahead and take him to Emergency Room.  We immediately took him to ER at 11:22am, was triaged within 5 minutes and brought back to emergency room within 10 minutes.  Doctor ordered: labwork (blood), sterile urine culture (via catheter), chest x-ray, ct scan with contrast of chest to groin and doctor's prognosis was tentatively kidney infection (although waiting for urine sensitivity cultures to complete and results from xay/ct scan.  All the while they kept checking his temperature which stayed elevated.  Gave him an IV and later added a Rocephin IV antibiotic.  The doctor noticed he had inflamed kidney(s?) and as a consequence decided to admit him to pediatric unit (6 hours after arriving at ER).  Also, gave his regular meds as listed above, children's motrin, children's tylenol suppositories. 10.  day 11 through day 15 (Sunday 11/22/2009 through Thursday-Thanksgiving evening at 6:00pm-also his birthday-11/26/2009):  admitted to pediatrics.  During hospital stay, was fever stayed elevated with range from 103 degrees to 105.9 degrees and on day released lowest temperature was 100.5 degrees.  During this time his rash went away, and his wiping/swiping his face and cheeks (somewhat diminished) and he (quit wiping/swiping his nose).  Did not eat much, not many break through seizures.   Continued with several more labs (blood work) with frequent several different intermittent alternating iv antibiotics.  When urine sensitivity cultures came back confirmed kidney infection they started him on a new antibiotic iv (Ampicillin).  On Wednesday, 11/25/2009, Immediately after he started the IV Antibiotic (Ampicillin), he started swiping/wiping his face/cheeks/nose even more and his nose started slightly running clear, although rash on cheeks/nose did go away during his stay, it  did not reappear again.  Also, his swollen lips reduced to lightly chapped.  On Thursday, his fever went down to around 100.5 degrees and the on-call doctor decided to release him from the hospital.   During his hospital stay, he was given his regular meds schedule as listed above, along with some  1.5% hydrocortisone cream and some moisturizing sensitive skin lotion (can't remember the name).  Additionally, released with antibiotics for 2 weeks, the