Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC
Symptoms: Musculoskeletal stiffness, Pallor, Upper respiratory tract infection
Clinical narrative: The night after receiving Prevnar, pt had 3 brief episodes of pallor, stiffening, (on 1st one, her eyes rolled back. No tonic movements. Lasted about 15 seconds. Pt was hospitalized for septic work=up and had nml EEG. The pt in a 2 month old white female previously healthy who presented to the ER this AM with possible apnea times three. The pt was seen at the clinic for routine physical exam. She received her immunizations. Mother stated that she had had some cold symptoms for approximately 3 weeks but otherwise has been well. She has been feeding well and not been irritable and had no history of fever. She was given, as stated, her immunizations the afternoon prior to admission. Mother stated throughout the afternoon, she was somewhat fussy and had been using Tylenol every 4 hours. She had been started on some amoxicillin per MD for history of prolonged URI, however, the mother had not given her a dose of antibiotics. At approximately midnight tonight the mother stated that she had laid in her bed and she had been somewhat difficult to go to sleep this evening and when she looked in on her, the pt was lying in  bed and appeared stiff, pale and her eyes rolled back. This was very brief, lasting less that stiff. No evidence at those points of tonic movement or eye rolling back. She had no history of cyanosis. Mother noted that she just appeared somewhat pale. There is an exposure to an older half sibling who has had cold symptoms but otherwise no exposure to illness. Past Medical History: A 6 pound 9 ounce full term product via C-section. No complications. Mother denies any maternal infections. She has stated that the child has had URI symptoms times approximately three weeks and has been on nystatin for approximately 3 weeks for thrush. Family history is as stated positive for an older half sibling with cold symptoms, otherwise negative. She lives with her parents and older half sibling which they have custody of approximately 50% of the time. Physical exam reveals a temperature of 98.1, pulse of 100 rectally. Pulse was 154. Respiratory rate was 44. Blood pressure was 114/59. She had 100% pulse ox. She was alert and fussy but consolable. She had been taking her bottle well. Exam revealed nasal stuffiness, otherwise negative. Tympanic membranes are clear. Oropharynx was clear. Anterior fontanelle was soft and flat. The pt was admitted with the dx of possible apneic event rule out seizure. She was admitted, placed on a monitor. She was also begun on antibiotics pending culture results with ampicillin and cefotaxime. She was placed on Diflucan for thrush and maintenance IV fluids. She continued to do well with really no problems over the next 48 hours. Cultures remained negative. She had no further episodes while she was hospitalized. DISCHARGE DX: Apnea episode with negative workup, possibly could have been a Sanderford syndrome. The pt had eaten approximately 45 minutes prior to the episode which would be consistent with the arching and eyes rolling back. I did feel she would benefit from an appointment with outpatient Pediatric Neurology regarding possible seizure event versus Sanderford's. We, however, did not start any seizure medications since this was all brief and no further episodes and normal EEG. The plan is to continue a home apnea monitor and continue her Diflucan. -DC Summary for 2 day LOS submitted with VAERS report by Maury Regional Hospital. HX: Presented ED with possible apnea times three. During today's routine PE in physician office she received her immunization. patient had cold symptoms for 3 weeks prior to visit. Became fussy after immunization medicated with Tylenol every 4 hours. Begun amoxicillin for prolong URI but mother had not begun to administer the medication. During the night patient appeared stiff, pale and eyes rolled back, very brief lasting less than 15 second and she had 2 secondary episodes both time she was just stiff. No evidence during PE in hospital of tonic movement or eye rolling back. No HX of cyanosis. PMH: URI symptoms for 3 weeks been on nystatin for 3 weeks for thrush. PE: Temp 100 (R). Pulse ox 100%. Alert fussy. Remainder of exam WNL. RX with Diflucan and IV fluids DC DX: apnea episode with negative workup, possibly could have been a Sanderford syndrome. Recommend appointment with pediatric neurology. DC instructions: continue Diflucan and home apnea monitor.