Age: 1.13
Sex: M
Vaccine: HBHEPB, VARCEL
Symptoms: Pyrexia, Rash
Clinical narrative: Our son is a 14 month old male with hydrocephalus. He has a VP shunt that was placed 4 days after birth of 5/20/03. His medical history included a shunt revision on 7/3/03 as well as a series of hospitalizations for either possible shunt issues or seizures. Three of his seizures and hospitalizations occurred the day of, or the day after receiving immunizations. The following is an account of his most recent seizure which occurred the same day he received his most recent immunizations. He was given two injections on 6/30/04 at approximately 11:30 AM for childhood immunizations, Varicella vaccine and ComVax for MMR. The vaccines were administered under the direction of a doctor at the clinic. We provided medical records from his previous physician regarding the 2 other incidents of seizure following his immunizations in September and November of last year. After a discussion with the doctor, and prior consultation with a neurologist, the doctor recommended that he receive only 2 of his 3 scheduled shots, the decision was made to suspend the vaccine for DTP for at least 6 weeks. The doctor's office consulted with another doctor about controlling the fever associated with giving immunizations, as this was the suspected cause of the seizures. The doctor recommended Tylenol be given every four hours around the clock in order to control the fever and prevent a seizure. At approximately 10:30 PM on the same night, 6/30/04, he began seizing in bed at approximately 10:30 PM. His left arm and left leg were uncontrollably moving up and down. At 10:35 PM, we administered his prescription medication, Diastat, which is suppose to stop the seizures. At approximately 11:00 PM, the seizure was still occurring, although less severe. We called 911 and he was taken to the hospital at approximately 11:30 PM. The seizure stopped by the time he arrived at the hospital around midnight. This initial seizure lasted more than one hour. He was initially seen by the emergency room physician, blood was drawn, and an IV started. He had a CT Scan and x-ray's of his shunt to check for potential blockage. I believe this was in response to my comment to the emergency room physician that he had a shunt revision in July 2003, when the shunt was blocked with protein according to his neurosurgeon. The results of his CT scan was negative and shunt issues were ruled out. He had a second seizure about 2:15 AM that lasted approximately 70 minutes. This time the seizure was on the right side of his body, and was violent in nature. The emergency physician gave him a series of injections that included Adavan and Phenobarbital, to stabilize him. These injections brought about little response and the seizure continued. A respiratory therapist administered oxygen to him until he was transferred to the triage room after about 50 minutes of non-stop seizing. The emergency physician gave him more Ativan, and was preparing to give him a drug to lose consciousness when the seizure stopped. At approximately 4:00 AM, his seizure stopped and at approximately 4:20 AM a decision by the emergency physician to complete a spinal tap before transferring him to ICU approximately at 5:00 AM. He was seen by the ICU staff physician upon entering ICU. A neurologist was assigned to him along with a member of the hospital's pediatric group. His phenobarbital dose was raised from 6ml twice daily to 8ml twice daily. On 7/1/04, he was transferred out of ICU to a regular hospital room. It was noted that he had a red rash all over his trunk and face for several hours that day. He stayed in the hospital another night and was discharged on 7/3/04. He slept most of the day on Saturday, taking in very little liquids. He continued to remain lethargic and irritable. His rash reappeared for a couple of hours on Saturday. Sunday, 7/4/04, he continued to be lethargic and slept most of the day. Today, Monday, 7/5/04, he appears to more of himself, he smiles, is more alert and has taken in liquids and baby food as normal. Follow Up: Per vaccine provider , the past immunization record is not clearcut , but they believe the Comvax is second dose in the series. No MMR was given on 6/30/2004.