Age: 48.0
Sex: M
Vaccine: FLU3, PPV, FLU3, PPV
Symptoms: Erythema, Hypokinesia, Mobility decreased, Oedema peripheral, Pain
Clinical narrative: Information has been received from a health professional concerning a 48 year old male with congenital heart disease, coronary artery disease, type II diabetes, hypertension, hyperbilirubinemia and history of hernia repair, family history of diabetes and heart disease and no known allergies who on 25-JAN-2007 at 4:30 PM was vaccinated with a first dose of Pneumovax 23 (0.5 ml) (lot # 655152/0889F), in the left arm. Concomitant therapy that day and time in the same arm included a first dose of Fluvirin (lot # 72223), in the left arm. Other concomitant therapy included metformin, Altace, "baby aspirin", glipizide, Lipitor, Toprol and Bactrim. On 25-Jan-2007, in the evening, the patient had soreness, pain, redness and could not lift his arm over his head. The patient contacted the office on 26-JAN-2007 and came into the office and was treated with Advil and ice and sent home. The patient went to the emergency room on 27-JAN-2007 was evaluated and sent home. On 28-JAN-2007 the patient was admitted to the hospital "after having had an influenza vaccine to the left upper extremity three days prior." He had returned one day before admission with extension of the redness, and arrangements were made for admission. It was also reported that he was seen in the ER two days before admission when he had some redness extending from the redness extending from the arm down to the forearm. It was reported that he was given Ancef and allowed to go home on Bactrim. He developed increased redness and swelling, as well as subjective fever and chills. He was sent in the emergency department, placed on vancomycin, and then admitted to observation. The patient did get itching of the neck and head with the second dose of vancomycin. It was reported on 29-JAN-2007 that an exam was remarkable for redness, swelling and tenderness of the arm, with extension down to the forearm. "He got vancomycin last night and received some itching. He also got some oaxcillin, then switched to Invane." On 29-JAN-2007 the patient had chief complaint of left upper extremity swelling of some three days duration. The evening of vaccination he had more pain in the arm than usual. There was some discomfort on bending the elbow, however, if he took it slowly, there was no pain. There was no swelling around the elbow. There was no drainage from the injection site of the flu shot and he had no pain on motion around the shoulder. He had no fever or chills. He had no drainage. His glucose had stayed at about 200. A 13-point system review, was negative. Infectious disease was consulted and consented to follow the patient in the office and IV antibiotics, and then he was discharged to their office to be followed by a physician, IV daptomycin. The patient was discharged with a diagnosis of left upper extremity cellulitis, hypertension, controlled, stable coronary artery disease, diabetes mellitus type II, hyperbilirubinemia (question Gilbert's syndrome). The patient was discharged on Altace, aspirin, Glucophage, Glucotrol, metoprolol and simvastatin (MSD). The patient recovered. Additional information is not expected.