Age: 5.0
Sex: F
Vaccine: UNK, VARCEL
Symptoms: Drug administration error, Laboratory test abnormal, Lung disorder, Medication error, Rash vesicular
Clinical narrative: Information has been received from a physician concerning a 5 year old female patient with a medical history of oral candidiasis and HIV+ who on 9/20/03, 3 weeks ago, was inadvertently vaccinated with a dose of varicella virus vaccine live as well as other vaccines (therapy unspecified). Subsequently, the patient developed disseminated varicella (and what initially sounded like) that died, however, clarification from the physician indicated that the patient did not die. The patient was hospitalized and was transferred to the reporting physicians's hospital on 10/9/03, with a rash all over the body. The child developed pulmonary HIV lung changes but the physician was not sure if the child had pneumonia or if it was bacterial or viral. It was also noted that the physician was not sure if the child had been officially diagnosed with HIV at the time of vaccination but she has been now and is quite immunocompromised. The child had been treated with acyclovir x3 days and was improving. She was beginning treatment with antiretrovirals but specific therapy and start date was unknown. Lab data revealed a total T cell of less than 20 and CD4 of 3%. A vesicular specimen and swabs have been collected. Additional information has been requested.  Follow up on 11/05/2003: "Information has been received from a physician concerning a 5 year old female patient with a medical history of oral candidiasis and "HIV+" who on 09/20/2003, "3 weeks ago", was "inadvertantly" vaccinated with a dose of varicella virus vaccine live (Oka/Merck) "as well as other vaccines" (therapy unspecified).  Subsequently, the patient developed "disseminated varicella" (and what initially sounded like)" "that died", however clarification from the physician indicated that the patient "did not die".  The patient was hospitalized and was transferred to the reporting physicians' hospital on 10/09/2003, with a rash all over the body.  The child developed "pulmonary HIV lung changes" but the physician was not sure if the child had pneumonia or if it was bacterial or viral".  It was also noted that the physician was not sure if "the child had been officially diagnosed with HIV at the time of vaccination but she has been now and is quite immunocompromised".  The child had been treated with acyclovir x 3 days and was improving.  She was beginning treatment with "antiretrovirals" but specific therapy and start date was unknown.  Laboratory data revealed a "total T cell of less than 20 and CD4 of 3%".  A vesicular specimen and swabs have been collected.  In follow up, it was noted that both samples were inadequate.  Additional information has been requested." Follow up on 11/13/2003: "Follow up information from the physician indicated that the child was home and had recovered from the varicella.  "Her pulmonary changes are related to her HIV and she did not have any varicella related pulmonary diagnosis."  The child was seen in the clinic recently and continues on antiretrovirals to treat her HIV.  Additional information has been requested." Follow up on 11/25/2003: "Follow up information was received from a health professional at the VZV identification program who reported the results of the swab specimen from the patient's vesicle obtained on 10/10/2003 and the scab specimen obtained on 10/15/2003.  The specimens had been sent to the laboratory on 10/16/2003 and the specimens arrived in the laboratory on 10/17/2003.  The interpretation showed an adequate specimen and the final results reported on 11/07/2003 showed that VZV DNA was amplified, and the VZV strain identified was the vaccine type.  The PCR analysis contained the virus strain from varicella virus vaccine live (Oka/Merck).  Additional information was received from the physician who indicated that the pt was vaccinated with varicella virus vaccine live at a health center. No further information is expected."