Age: 0.08
Sex: F
Vaccine: DTAPIPVHIB, HEP, PNC13, RV5
Symptoms: Urticaria
Clinical narrative: Per telephone encounter on 2/26/21: Mother verbalizes that patient received 2-month vaccines on Tuesday 2/23/21. Injection sites were slightly red, and patient had a low-grade temperature, so they gave patient Infant Tylenol. Patient was okay afterwards and injection sites were no longer red. However, last night 2/25/21 mother noticed small red bumps on bilateral legs. This morning 2/26/21 the small red bumps are now also on bilateral arms and some on her neck. Mother is wondering if this is related to the vaccines or if it could be related to the Vitamin D drops, they also started on Tuesday 2/23/21. Afebrile. No other symptoms currently. Bumps do not seem to bother patient. Eating and sleeping normal. Denies drainage. Same day appointment scheduled with Dr. on 2/26/21. Dr.'s note after appointment on 2/26/21: 1. Rash and nonspecific skin eruption; Clinical Notes: 7-week-old infant presents to the office for follow-up evaluation of generalized rash which started 48 hours after her vaccine administration. Rash started as a few erythematous lesions and became generalized over the last 24 hours. She is eating well and does not have any vomiting or diarrhea. She has no URI symptoms cough or congestion. She has no fever. She appears well on today's exam. The appearance of rash after 48 hours of vaccination is concerning for a delayed hypersensitivity reaction but unlikely to be IgE mediated response. I would like to obtain consultation with allergy immunology regarding the etiology of the rash. The only booster that she has received is hepatitis B, other vaccines have been given for the first time on 2/23/2021. I will plan to report the rash to VAERS and also seek consultation from National advisory committee web portal via electronic communication. This will help us to figure out if the next set of vaccinations can be given safely. Referral sent To: Allergy/Immunology: Reason:7-week-old infant has generalized erythematous maculopapular rash almost like urticarial vasculitis. Please evaluate for allergic/drug reaction due to vaccination. Dr.'s note after appointment on 3/2/21: Clinical Notes: Patient recently had urticaria for 2 days, occurring 2 days after routine childhood vaccines. She was also feeding on milk-based formula, but the hives seemed to resolve after changing from milk (and also avoiding soy). Mother has a lot of soy in her diet. Still receiving some breast milk also. The reaction was unlikely due to any of the vaccines, and even if the vaccines were related, there were no symptoms to suggest an immediate anaphylactic reaction. Any vaccine can also cause some local swelling or rashes or low-grade fevers due to the normal immune response. Recommend continued vaccination according to the ACIP schedule. SPT for milk was positive and negative for soy, giving some evidence that the hives were due to cow's milk. Recommended to her mother continued avoidance of cow's milk and dairy, including in the mother's diet while still breastfeeding. Also discussed the signs/symptoms of anaphylaxis. Should this occur, use an Auvi-Q and go to the ER. If symptoms persist in 10-15 minutes, then use the second one. Carry 2 at all times. Proper use of Auvi-Q taught and also provided information for milk avoidance and referred to the website. Will f/u in 1 year to repeat SPT for milk. Call or f/u sooner PRN.