Age: 27.0
Sex: F
Vaccine: FLUA3, PPV
Symptoms: Pain in extremity, Pyrexia, Skin discolouration, Ultrasound scan, White blood cell count increased
Clinical narrative: This is spontaneous case, reported by other non-health professional to VAERS and initially retrieved on 07-Apr-2018 by Seqirus from VAERS (VAERS ID: 729803), concerns a 27-year-old, adult female patient. The patient's medical history was not reported. However, the patient's concomitant medication was NUVARING for an unknown indication. On an unspecified date in Nov-2017, the patient was administered with FLUAD (TIV) (dose: 0.5ml [unk as reported], route of administration: intramuscular, anatomical location: left arm) and non-company suspect PNEUMOVAX (dose: none as reported, route of administration: intramuscular, anatomical location: left arm) for an unknown indication. On 24-Nov-2017 (Friday), at 11:00 pm, the patient woke up with extreme pain in left upper arm and body aches. The patient went to stand alone ER (emergency room). The doctor told that it was just a severe inflammation and gave her an anti-inflammatory injection hydrocodone and TYLENOL 3 (reported as an Rx for TYLENOL 3). Over the next 36 hours, the patient took TYLENOL 3 which did not show much relief other than put to sleep. Subsequently, over the course of time and by Sunday on 26-Nov-2017 around 2:45 pm, the patient visited the hospital ER (emergency room) with extreme pain in left arm, swelling and redness covering the entirety of the upper left arm. Additionally, high heart rate and blood pressure, extreme headache upon movement, body aches, severely dehydrated, and a fever of 102.7. On the same day, the patient was admitted in the hospital. Chest X-ray and blood tests were performed. On 27-Nov-2017, blood tests and ultrasound of upper left arm was done. The patient's WBC (white blood cell) was reported as 29 (unit and normal range not reported) and the patient was diagnosed with cellulitis of the left arm. The patient was admitted treated with morphine, ibuprofen and intravenous antibiotics. The patient was kept on cardiac monitoring. The patient still had reddish/purple stain looking mark on the arm from the infection. On 28-Nov-2017, again patient had blood tests and ultrasound of upper left arm was done. On the same day (Tuesday evening), 3 days after admission, the patient was hesitantly released from the hospital with discharge medication BACTRIM and ibuprofen. The patient was monitored for temperature and asked to contact the doctor immediately or visit the emergency room if temperature runs again. The patient had recovered from all the events. The reporter assessed the case as serious (hospitalization). Follow-up received from other health professional on 19-Feb-2019: Literature information and reporter were added in the general tab. The description as reported was changed from "diagnosed with cellulitis of the left arm" to "diagnosed with cellulitis of the left arm/Left deltoid cellulitis for the event cellulitis. Reference number (US-SEQIRUS-201801445) was added in the additional information tab. No changes were done in the narrative. Reporter's Comments: A 27-year-old female patient was diagnosed with cellulitis of arm (Brighton collaboration level 2), general body pain, headache. Hypertension, increased heart rate, pain in arm, dehydration and increased WBC count, unspecified period after receiving FLUAD TIV and PNEUMOVAX. Based on uncertain time to onset for the events, the causality was assessed as unassessable. PNEUMOVAX will be considered as co-suspect.  The date of vaccination mentioned in the case is not in accordance with the onset of events in adverse event description, the case will be further assessed upon receipt of follow up information. This case was assessed as serious (medically significant).