Age: 75.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Swelling, Tenderness, Vaccine positive rechallenge
Clinical narrative: Information has been received from a registered nurse concerning a retired 75 year old Caucasian female pt with allergies to Zithromax, Lodine, EES, contrast dyes, Relafen and Levaquin and NSAIDS who on 15OCT2003 at 10:30 AM was vaccinated in the right deltoid with a first dose of pneumococcal 23v polysaccharide vaccine. Concomitant vaccine administered on 15OCT2003 at 10:30 AM in the left deltoid included a second dose of influenza virus sAg 3v vaccine inactivated. It was noted that the pt also had her first flu vaccine last year 2002. Concomitant therapy include Toprol XL tablets 100 mg QD, Prilosec 20 mg QD PRN, Diazide 37.5/25 QD, Levoxl 0.88 mg QD, K-Dur 20 mEq QD, Dovan HCT 80/12.5 QD and Lexapro 10 mg, Diovan HCT 80/12.5 QD and Lexapro 10mg. The RN reported that on 15OCT2003 at 18:00 pm (also reported as in the afternoon of 15OCT2003, within three hours of vaccination) the pt started to develop a severe local reaction , which got worse thought the evening. The nurse reported that by the evening the right upper rm was described as swollen, hot and painful and it kept the pt awake all night. The pt used a warm pack with little relief. The nurse reported that when the pt was seen the next AM 16OCT2003 the pts arm had significant swelling with erythema of entire upper arm. The swelling and redness is from the shoulder to the elbow and the arm is tender to touch. It was noted that the pt stated, "hurts so much". It was also noted there was no obvious swelling. While in the office, ice was applied to the site and the pt appeared to be feeling somewhat better. The pt's temperature was taken axillary and oral as 98.9 degrees F. The following lab tests were done and the results reported as follows: PT-10.8, INR 1.07, CBC all normal except HgB 11.9, Hct 36.8, MPV 8.6 all were slightly low). Platelets 170x 10 3U/L. the nurse reported she did not know whether the pt took anything for discomfort. In follow up information it was noted that the pt was instructed to ice her arm, take Benadryl and she was given prescriptions for lorazepam 0.5 1/2 tablet every 6 hours as needed, and Darvocet for pain. It was noted that the pt believed, "this was her fist dose of pneumococcal 23v polysaccharide vaccine ever". The nurse also reported that the patient had a lesser, but similar reaction to the influenza virus sAg 3v vaccine inactivated this year (administered 15OCT2003 in the left deltoid) and to the first dose of influenza virus vaccine in 2002. The reactions to the influenza virus in 2002 were reported as mild rxns, ecchymotic with lump on right arm (also reported as black and blue at the injection site with tenderness). The RN reported that as of 17OCT2003 the pt was improved, and as of 04NOV2003 the pt only had "slight itch in upper arm". The pt had no illness at the time of vaccination. There was no other date at this time. There was no product quality complaint involved. Additional follow up received from the registered nurse confirmed the pt recovered and that the pt has had no problems since 17OCT 2003. Unspecified medical attention was sought. No additional information is expected.