Age: 1.01
Sex: F
Vaccine: VARCEL
Symptoms: Rash, Rash pustular, Viral infection
Clinical narrative: Information has been received from a health care professional concerning a 34 month old white female, with a history of impetigo on her legs, eczema, molluscum and warts who on 09-OCT-2003 was vaccinated with a first 0.5 ml subcutaneous dose in the left arm of varicella virus vaccine live (Oka/Merck) (Lot# 645291/0201N). It was reported that the patient developed a severe rash that started on 18-JUL-2005 as a large pus filled, lesion on the patient's left buttock. It spread up the left side of her back. It did not seem itchy. The patient had a fever of 101 F for one day only. In an office visit on 18-AUG-2005, the patient presented with some areas of her rash oozing and other areas were scabbed. At the time of the report there was a rash on her face which was scabby and weepy, and a lesion on her abdomen. The physician diagnosed the event as probable varicella with some secondary infection. The patient was being treated with cephalexin (KEFLEX), diphenhydramine hydrochloride (BENADRYL), and avena (AVEENO BATH). It was noted that the patient was to return to the office if the rash worsened or she developed a fever. No further information is available. Follow-up information from a health care professional that the rash started on her left buttock and was a large lesion that actually drained some pus. From there, she developed a rash around that area and then it spread up the left side of her back, around her chest and then back around to the right side of her back. It spread a little to her face. It was noted that the patient was at the beach last week and there were no others with a rash. It was reported that on examination the patient was an alert female, in no distress. HEENT exam was within normal limits, heart and lungs were normal, and her abdomen was benign. Her skin revealed a large patch of molluscum and eczema in the left popliteal fossa. She did have a healing lesion on her left buttock. She had multiple, of what appeared to be, ruptured vesicles on her back, chest, legs, and a few on her face. A few were weepy, some were scabbed over. She also had a few papulovesicular lesions on her right upper shoulder with an erythematous base. She had a wart on her left wrist. The assessment was probable varicella with some secondary infection. It was noted that treatment will go ahead with cephalexin (KEFLEX), 250 mg per 5 ml, 1 tsp t.i.d. for 7 days, diphenhydramine hydrochloride (BENADRYL) for itching, and avena (AVEENO BATH). It was noted that the patient had an appointment for next week with a dermatologist to look at her molluscum and eczema and if the rash was not better by that point to review that as well. The patient was told to return if the rash worsened, fever recurred or had any other concerns. Follow-up information from a health care professional indicated that the patient started "two days ago", on 16-AUG-2005, with a rash on her neck and behind her ears. It was slightly itchy and there was no fever or other symptoms. It was noted that the patient had recently gotten over varicella. It was reported that she was alert and pleasant. She had multiple hypo pigmented spots on her lower extremities with a large cluster of molluscum behind here left knee. There were multiple open sores on her lower neck extending to the clavicular area particularly over the right clavicle. There was no obvious discharge and minimal swelling. They were non-tender to her. She had some healing warts as well on her thumbs. The assessment was impetigo, eczema, molluscum, and warts. Treatment included cefadroxil (DURICEF), 250 mg, b.i.d. for 10 days, topical bacitracin zinc (+) neomycin sulfate (+) polymyxin B sulfate (NEOSPORIN), and a follow-up as needed. Additional information has been requested.