Age: 84.0
Sex: F
Vaccine: PPV
Symptoms: Cellulitis, Erythema, Injection site reaction, Injection site swelling, Pain
Clinical narrative: Initial and follow up information has been received from a registered nurse, concerning an 84 year old retired female inpatient (25-FEB-2006), with several allergies to antibiotics (erythromycin, ciprofloxacin hydrochloride (CIPRO), allergic reaction to sulfamethoxazole 9+) trimethoxazole (+) trimethoprim and trimethoprim, severe electrolyte imbalance, nausea, vomiting, diarrhea, hypomagnesaemia, hyponatremia, hypokalemia, and hypertension (difficult to control), who at 11:20 am on 26-FEB-2006 was vaccinated subcutaneously with a 0.5 ml dose of pneumococcal 23v polysaccharide vaccine (Lot#651320/1008P).  Initially the nurse reported that on 27-FEB-2006 about 24 hours post vaccination, the patient developed an injection site reaction.  The symptoms included swelling, a red rash at the injection site, pain, and a cellulitis.  At the time of the initial report the patient's present status was reported as recovering.  No product quality complaint was involved.  Follow up information from the nurse indicated that the patient was admitted to the medical center on 25-FEB-2006 with flu-like symptoms.  The lab and diagnostic tests revealed, urine specific gravity was 1.025 (high), urinalysis (revealed moderate bacteria, enteroccus faecalia, diagnosis urinary tract infection), blood glucose was 147 (high), creatinine 0.5 (low), sodium 118 (very low), potassium 3.0 (low), chloride 82 (low), serum osmolality 249 (very low), MPV 6.3 (low), neutrophils 76.0 percent (high), monocytes 12.5 percent (high), and lymphocytes 10.1 percent (low). Intravenous therapy (unspecified) was instituted.  The patient showed slow improvement.  Her blood pressure was controlled by changing her medication.  Magnesium supplement was instituted for correction of her hypomagnesaemia.  Diet was advanced.  The patient continued to show improvement.  On 26-FEB-2006 the lab and diagnostic tests revealed: BUN 7 (low), sodium 123 (low), potassium 3.3  (low), chloride 89 (low), calcium 8.1 (low), magnesium 1.4 (low), MPV 6.4 (low), lymphocytes 12.2 (low), monocytes 18.8 and (high).  The nurse reported that at 8:00 am on 27-FEB-2006 (one day after vaccination) the patient developed right upper arm swelling.  The patient's temperature was 98.1 and her pulse was 66.  At 20:35 on 27-FEB-2006 the right upper arm appeared abraded, there was swelling of the right deltoid, and a bright red rash at the deltoid.  On 27-FEB-2006, the lab and diagnostic tests revealed: BUN 5 (low), sodium 128 (low), chloride 93 (low) and calcium 7.9 (low).  On 28-FEB-2006, the patient's assessment continued.  Her temperature was 98.1 and her pulse was 66.  On 28-FEB-2006, the patient's assessment continued.  On 28-FEB-2006, the lab and diagnostic tests revealed: glucose 114 (high), BUN 8 (low), sodium 126 (low), chloride 91 (low), and magnesium 1.5 (low).  At 10:55 on 01-MAR-2006 the patient developed a red area with a yellow circle in the center.  At 13:30 the area of erythema was 3.5 by 4.0 inches in diameter with and irregular yellow area in center.  The patient reported that is felt "less sore".  On 01-MAR-2006 the patient was diagnosed with gastroenteritis and discharged from the medical center with valsartan (DIOVAN), 360 mg, propranolol hydrochloride 80mg twice a day, omeprazole (MSD), 60 mg daily, lorazepam 1 mg daily.  Therapy with hydrochlorothiazide (manufacturer unknown) which was previously given will be discontinued.  The outcome of the patient's experiences were reported as unknown.  The nurse noted that the patient had gastroenteritis and an urinary tract infection (probably viral) at the time of vaccination, and was treated.  The patient will be followed up at the clinic.  Additional information has been requested.