Age: 42.0
Sex: M
Vaccine: PPV, FLUX
Symptoms: Injection site joint inflammation, Injection site pain, Malaise, Musculoskeletal pain, Nausea
Clinical narrative: Information has been received from a pharmacist concerning a patient who on an unspecified date in November 2011 was vaccinated with a dose of PNEUMOVAX 23 (Lot# not reported). In November 2011 (reported as "2 days later after vaccination") the patient experienced fever, chills, pain and redness around the injection site. The patient was admitted to the hospital for an unknown period of time, treated and released. At the time of reporting, the patient's outcome was unknown. Follow-up information has been received from medical records regarding a 42 year old male with a history of appendectomy for acute appendicitis (hospitalized 18-NOV-2011) who on 19-NOV-2011, was given a dose of PNEUMOVAX 23 intramuscularly in the left arm (also reported as left shoulder). It was noted that on 20-NOV-2011, the patient felt good. On 21-NOV-2011, the patient presented to a physician's office with a complaint of general malaise, headache, generally not feeling well, felt "horrible". The physician sent the patient to the emergency room where his white count was found to be elevated at 16.9 with a shift. It was noted the patient had had a normal white count with his appendicitis with a small shift. The patient's urine was clear, chest x-ray was normal, CAT scan of his abdomen was unremarkable. The patient's SMA7 revealed a mildly elevated glucose. Physical examination was essentially benign except for a red, tender, somewhat indurated patch on the patient's left arm where the PNEUMOVAX 23 was administered. The patient complained of intermittent fever, chills, headache, nausea with an episode of vomiting, and body aches. Temperature in the emergency room was low grade, however, the patient indicated it was 101.6 at home. Impression included possible bacteremia secondary to inoculation from the pneumococcal vaccine versus a viral syndrome. Plan included less than 24 hour admission for observation. Repeat CAT scan was entirely negative. The only etiology for the patient's pain was a reddened arm located around his pneumococcal shot (also reported as shoulder pain). The patient was hospitalized. Infectious disease was consulted, impression from which included inflammatory focus on the left shoulder, most likely the source of the patient's fever, chills, and systemic symptoms. It was noted this could all be a local reaction to the pneumococcal inoculation the patient received recently. "Would however, be concerned about the possibility of a bacterial superinfection, most likely a gram-positive organism, staph aureus or beta strep, and this too could be causing the systemic symptoms he is describing." The patient seemed to have a transient shedding of toxin and a transient bacteremia. He was placed on vancomycin and switched over to (UNASYN). Blood culture at five days showed no growth. Over the next two days, the patient began to feel much better and returned to his normal state. The redness in his arm went down; there was no fluctuance to suggest abscess. The patient's white count returned to normal, and the patient felt fine. On 23-NOV-2011, the patient was discharged on AUGMENTIN with a heating pad to his arm. All available medical records will be provided upon request. No further information is expected.