Age: 3.2
Sex: M
Vaccine: PPV
Symptoms: Difficulty in walking, Injection site erythema, Injection site oedema, Injection site pain, Injection site swelling
Clinical narrative: Information has been received from a nurse practitioner concerning a 3 year old male with sickle cell anemia and no known allergies who on 4/8/03 at 14:30 was vaccinated in the left anterolateral thigh with a first dose of pneumococcal vaccine 23 polyvalent. There was no concomitant vaccination. On 4/8/03 at 1700 the pt developed "pain in his leg," "swelling" which extended from the injection site to his left knee, a fever of 101.5 degrees F and the area was warm to touch. The pt was treated by his mother with Tylenol with codeine. Subsequently, the pt was taken to the hospital and was admitted. He received morphine in the hospital. On 4/16/03 it was reported that the pt spent 2 days in the hospital and was discharged "sometime last week." At the time of discharge, the pt had not completely recovered. It was also reported that the pt was now doing "better." He still had swelling and was not putting much weight on the left leg. The reporter noted that the child was "toe walking." She noted that the area was no longer warm to touch, but was still swollen. She indicated that she had not heard back from the pt's mother since he was discharged from the hospital. Additional info has been requested.  The follow up received on 5/20/03 received from a nurse practitioner concerning a 38 month male with hemoglobin sickle cell anemia and no known drug allergies who on 4/8/03 at 1330 (previously reported as 1430)was vaccinated IM in the left anterolateral thigh with a first 0.5ml dose of pneumococcal vaccine 23 polyvalent (644106/0819M). Concomitant medication included folic acid 1mg PO QD and Amoxil 250mg PO BID. There was no illness at the time of vaccination. It was also reported that in March 2000, August 2000 and February 2001 the pt was vaccinated with a dose of Prevnar and had no known adverse events following vaccination. On 4/8/03 at 1700 (also reported as at 2100 and at 12 hrs after vaccination) the injection site on the anterior surface of the pt's left thigh became warm, swollen, erythematous, and painful. The pt had "pain in his leg," "swelling" which extended from the injection site to his left knee and the area was warm to touch. On 4/8/03 at 1500 the pt was treated by his mother with Tylenol with codeine with no improvement of his pain and no relief. On 4/9/03 at midnight the pt developed a temperature of 101.5 degrees F, was crying with pain and was unwilling to bear weight. He was taken to the hospital emergency room and was given morphine for relief. On 4/9/03 "due to this drug reaction" the pt was admitted to the hospital for IV fluid, pain management and control with Motrin and IV Rocephin. It was reported that the pt required no oxygen or blood transfusions and never required IV morphine sulfate prn. On 4/9/03 a hemoglobin/hematocrit was 8.7 and 25.9 and blood culturs were negative after 1 ay. A final blood culture was still pending. On 4/10/03 the pt was discharged from the hospital with no reported problems. It was also reported that at the time of discharge, the pt had no completely recovered and was now doing "better." He still had swelling and was not putting much weight on the left leg. The reporter noted that the child was "toe walking." She noted that the area was no longer warm to touch, but was still swollen. The pt was discharged on folic acid, Tylenol #3 suspension 5ml PO q 6hr prn, Motrin 100mg q 6 prn and amoxicillin 250mg PO BIC. He was to have a follow up appointment in 6 months "as previously scheduled" or sooner if needed. It was also noted that the reporter had not heard back from the pt's mother since he was discharged from the hospital. On 5/20/03 it was reported that it was unknown if the pt had recovered. Additional info has been requested. A 15-day follow up report received 9/5/2003 adds: On 08/19/2003 it was reported that the pt recovered. Additional info is not expected.