Age: 0.23
Sex: F
Vaccine: DTAPIPVHIB, PNC13, RV5
Symptoms: Injection site swelling, Injection site warmth, Irritability, Musculoskeletal stiffness, Myoclonus
Clinical narrative: Former 32 week preemie, received PENTACEL, ROTATEQ and PREVNAR 3/31/15. Red, hot swollen leg noted 4 hrs later, through evening pt had 3 episodes of very exaggerated startle reflex, one episode myoclonus. No fever at that time but developed fever to 102 next AM. Had several spells of choking, turning blue, apneic x 20 min with AM feed. The patient is a 12 week old female who presents for a follow up. This is a follow up visit for other (she was here yesterday for her 2 mo immunizations). Received PENTACEL in right leg, PREVNAR in left leg, and ROTATEQ by mouth. Right leg with some swelling, redness and warmth yesterday. Then last night mom noticed 3 episodes, about 15 secs apart, where patient had "stiffening of her legs and arms", and eyes rolled back in her head. Mom states that it was almost like an exaggerated startle reflex. Episodes lasted about 3 secs each. About 4 AM today, her left leg straightened, and then Dad saw some bouncing of her leg. This AM she woke up with a fever of 102. Her breathing has also been faster, louder, and more irregular than usual. Also, this AM she has had about 6 episodes of breath holding, and turning blue while taking her MBM bottle. Mom has blown in her face, and then she breathes again. She's been spitting up more forcefully and frequently than she did before yesterday. Child seemed perfectly well before getting vaccines yesterday AM, no fever, feeding well and gaining well. Parents are medical professionals (dad general surgery, mom RN) with no vaccine prejudices; older brother is fully vaccinated without any problems. As per yesterday's notes, after getting PENTACEL, PREVNAR and ROTATEQ developed marked fussiness, right thigh (site of PENTACEL) was red, hot and swollen. She did have an unusually loud cry and was very difficult to console. I saw her back in the office about 5 hours later and did confirm all the above findings. Afebrile on both visits. She continued to be very fussy through the night and did get BENADRYL and TYLENOL at about 6 PM. Increased salivation noted. At 9 PM mom started to change her diaper and patient had an unusual movement "like an exaggerated startle reflex" in which she stiffened, arms flew out in front of her with fingers spread, legs stiffened and toes pointed down, and her eyes grew very wide, then rolled back in her head. This only lasted about a second but was repeated 3 times over a minute. Then at midnight dad observed "myoclonic jerking" of left leg for a few seconds. She did vomit once last PM and has continued to spit up more than usual this AM. Temp of 102 at 8 AM today; mom was monitoring temperatures yesterday and those were normal. No fever noted at the time of the unusual motor movements. At 8:30 feed this AM child was fussy, crying and choking with feeds to the point of turning blue, apnea lasted for about 20 seconds. Several times mom had to withdraw bottle, blow in child's face and stimulate her to resume breathing. Last TYLENOL at 8 AM this AM, no fever here. Fed ok at 12:30 today.