Age: 1.3
Sex: F
Vaccine: MMR
Symptoms: Laboratory test abnormal, Musculoskeletal stiffness, Pyrexia, Rash, Vomiting
Clinical narrative: Information has been received from a woman in a physician's office and a consumer concerning her 16 month old white daughter, with no past medical history or known allergies, who on 5/24/02 was vaccinated SC with the first dose of MMR (second generation) (lot # 642181/0183M), administered in the left arm. There was no concomitant medication or illness at the time of vaccination. ON 6/10/02 the patient developed fever, cough and was very tired. On 6/13/02 the patient experienced a seizure and was hospitalized. She was diagnosed with a febrile seizure. She remained hospitalized for the next two days. It was reported that as soon as her fever broke, she broke out in a rash all over her body. The woman in the physician's office reported that the seizure was not associated with the vaccination because the patient's sister who was not vaccinated with MMR (second generation) also had similar symptoms of a fever and a rash. Follow up information was received, from the physician, on 9/24/02. Twenty-one days post vaccination, on 6/14/02 (also reported as 6/10/02 and 6/13/02), the child developed a fever. That same day (previously reported as 6/13/02), she developed seizures times 3, for which she was hospitalized, for a duration of one day (previously reported as two days). Admission and discharge diagnoses were febrile seizure and fever, rule out sepsis. According to the hospital discharge summary, the child's parents noted that she was having increased temperature the day prior to admission, measured at 101 degrees F. Her parents administered acetaminophen which helped the fever. They denied any recent upper respiratory tract infection symptoms, earache, nausea, vomiting, diarrhea, or rashes. They stated that the child's appetite and fluid intake had been good on the day prior to admission. The parents described the event as a seizure at approximately 5:00 AM the day of admission which involved her eyes rolling back into her head. The child was described as stiff and had been making shaking movements and strange vocalization. The episode lasted approximately four minutes. During the episode, the child vomited once. She was tired thereafter and was taken to a healthcare facility (type not specified). Upon exam, she was observed to have a red throat and was discharged with amoxicillin. The parents stated that they gave her two doses overall. A second seizure episode was noted at home at approximately 5:00PM, which was similar in nature. This episode also included foaming at the mouth and a slight bluish discoloration around the mouth. The child was taken to the same healthcare facility and from there, transferred to a hospital. Her parents reported that at the time of the second visit, the child's temperature was 105 degrees F. Vital signs upon admission to the hospital emergency room were as follows: temperature 38.7 degrees C, pulse 153, respiratory rate 48, and oxygen saturation 98% on room air. Physical exam, at that time, was unremarkable. Septic work-up was performed which included: lumbar puncture, CSF culture, blood culture, CBC, urinalysis, and urine culture. The patient was treated with IV fluids, ibuprofen, and ceftriaxone sodium. While in the ER, the child had a witnessed tonic/clonic seizure lasting approximately one and one half minutes. During that time, oxygen was administered. Vital signs, upon admission to the pediatric floor were as follows: temperature 38.9 degrees C, heart rate 150, and respiratory rate 32. She was sleeping, but awoke easily. Physical assessment was unremarkable except that the left tympanic membrane was obscured by cerumen and was not visualized, throat was slightly erythematous, and cervical lymph nodes were shoddy. Lab findings at the time of admission included: WBC 8.2, HGB 12.7, HCT 37.7, PLTS 403, Sodium 132, Potassium 5.0, Chloride 103, Bicarb 21. CSF findings were as follows: protein 14, glucose 59, WBC 2, RBC 2. Urinalysis showed specific gravity of 1024, trace protein, no nitrates, and no leukocyte esterase. Cultures for blood, urine, and CSF were negative. Bacterial antigen detection was negative. No further seizure activity was observed and the child was discharged, that same day. Subsequently, the patient recovered. Discharge instructions included scheduling a follow up appointment with a primary care physician within 2-3 days following discharge. The physician confirmed that a rash developed when the fever resolved (date not specified) and that within 2 days, the patient's sibling at home developed fever and rash. It was noted that the patient's birth history was unremarkable, immunizations were up to date, and that she is developmentally on track. No further information is available.