Age: 53.0
Sex: M
Vaccine: HEPAB, TDAP, YF
Symptoms: Blood urea increased, Erythema multiforme, Full blood count abnormal, Lymphadenopathy, Lymphocyte count decreased
Clinical narrative: Initial report received from a health care professional on 22 November 2006. A 53 year old male patient received on 16 November 2006 Adacel (unknown lot number) and YF Vax (corrected) (unknown lot number) and the following concomitant vaccinations: Vaqta, Engerix B. On 17 November 2006 the patient received Oral Typhoid. Lot numbers, site and side if administration was unknown for all vaccines. On 19 November 2006, three days post initial vaccination, the patient developed pain, swelling of the right fifth finger. The patient moved to the left hip and nodules appeared on hands and feet. The nodules were itchy and tender, visibly noticeable. Corrective treatment was not reported. The patient was not severity ill but the signs and symptoms continued. At the time of this report (22 November 2006), the patient had not recovered. It was unknown if the patient had allergies, but the patient had no egg allergies. No illness at the time of vaccination. Prior exposure to the vaccines was not reported. Upon review of the case on 06 December 2006: a correction of the suspect drug "YF Vax" (formally reported as VF Vax) was made. Follow-up information received on 15 January 2007. Per the reporter, the patient has past medical history of allergy to Tetracycline. The patient was not taking any other medications at the time of the vaccinations on 16 November 2006. The statement in the previous narrative "but the patient had no egg allergies" was crossed out on the follow-up form by the reporter. Regarding the vaccinations on 16 November 2006; the patient received the vaccinations at 12:45 pm. The lot number for the Adacel was reported at C2638AA, and the vaccine was given intramuscularly in the left deltoid. The patient had received in the past a "Td" vaccine on 12 January 2000, and it was not reported whether any adverse events were associated with that vaccination. The lot number for the YF-VAX vaccine was reported as UE888AA, and it was given subcutaneously in the right upper arm. The patient had not received any received any previous doses of yellow fever vaccines in the past. The previously reported vaccines of Hep A and Hep B were amended to Twinrix, lot number AHABBO50AA, given intramuscularly, given intramuscularly in the right deltoid. This was the first Hepatitis A and B vaccine the patient had received. The oral Vivotif, lot number 3001132, was actually given on 18 November 2006, not 17 November 2006 as previously reported. The patient had not received any previous typhoid vaccinations in the past. The adverse events were amended to included right axillary node pain that began on 20 November 2006 with the left hip pain, and pruritic erythematous rash over the dorsum of both hands and plantar surface of both feet beginning on 21 November 2006. A dermatologist indicated the reaction was consistent with urticaria, possibly early erythema multiforme. The patient was treated with Atarax and Ibuprofen. A CBC, metabolic panel and urinalysis was performed (date not reported). The CBC revealed abnormal lymphocytes at 16% (normal range 26-46%) and WBCs were 7.1. The metabolic panel revealed abnormal BUN at 22 (normal range 7-18) with normal ALT, AST, and "lytes". The urinalysis test was normal. Per the reporter recovered from the adverse events on 01 December 2006. Follow-up information received on 09 February 2007. The final diagnosis was urticaria. The patient did not follow-up with a physician but not reported resolution of all symptoms on 14 December 2006.