Age: 0.01
Sex: F
Vaccine: HEP
Symptoms: Agitation, Blood bilirubin increased, Coombs direct test positive, Crying, Dermatitis atopic
Clinical narrative: Information has been received from a physician concerning a 2 day old female who was exposed in utero to the varicella virus vaccine live who on 20Mar03 was vaccinated IM with a first dose of hep B virus vaccine rHBsAg (yeast). On 22Mar03 the pt developed jaundice to her ankles. On 23Mar03 her bilirubin was high at 19.2mg/dl. It was noted she was s/p triple photo and an increase in fluids was ordered. On 23Mar03 her bilirubin was 17.2 mg/dl. On 24Mar03 her bilirubin was high at 22.2 mg/dl and it was noted that she was icterus to just below the knees and was jaundiced. She was noted to be on her second day of lights. She was noted to be alert, had a lusty cry, a strong suck, and was afebrile. A Coombs test was reported as positive. On 26Mar03 she was off the lights. On 27Mar03 her bilirubin was 12.9 mg/dl. On 28Mar03 she was icterus to the mid-thigh, her bilirubin was high at 14.0 mg/dl. The plan was to continue breast feeding, and use pump breast milk 4-5x/day after being breast fed. On 31Mar03 the pt was noted to have icterus to the symphysis pubis. Bilirubin was high at 11.8 mg/dl. The pt was alert, in no apparent distress and it was noted that no further follow up was needed On 21Apr03 the pt was vaccinated IM with a second dose of hep B virus vaccine rHBsAg (yeast) (lot 644142/0832M). On 20May03 the pt was vaccinated IM with a first dose of diphtheria toxoid (+) pertussis acellular Biken vaccine (+) tetanus toxoid (Tripedia) (lot U0851DA), a first dose given SC of poliovirus vaccine inactivated (Ipol) (lot W0626), a first dose given IM of Hib conj vaccine (tet toxoid) Acthib) (lot UA805AB), and a first dose given IM of pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (Prevnar) (lot 490900). On 09Jul03 the mother called the office to report that the pt, at three months old, had trouble breathing off and on and sounded noisy. She was not coughing. She was sleeping and feeding and happy. It was noted that nasally transmitted (illegible) and laryngomalacea (not further specified) was discussed. On 10Jul03 the mother reported that the pt was having frequent bowel movements every 2 hours (also reported as 3-4x a day). The pt was being breast fed and on formula. She was eating and acting OK and had no fever. Dietary changes were discussed such as hold on changes, pull out 1 thing or go back to breast feeding and then add slowly again. On 14Jul04 an attempt was made to call back to mother x2 with no answer. On 16Jul03 at 0916 the mother telephoned the office and reported that the pt had diarrhea x 10 days with 8-10 loose stools/day. It was noted that the baby needed a weight check. At 1500 that day the mother brought the pt to the office. She was alert, happy, drooling, talking and smiling. She weighed 17 lb, 4.2oz. Her skin and severe impetiginized atopic dermatitis with severe seborrheic dermatitis of the head behind the ear with an impetiginized lesion of the right upper shoulder. The diaper was noted to have light green seedy somewhat sticky stools that appeared normal. On 17Jul03 the pt was seen for a well child visit and was also noted to have moderate to severe eczema/seborrheric dermatitis. The pt was started on a skin regimen and looks much better today. It was noted that she had about 2 loose stools/day and was being evaluated with a stool culture. The pt also had an erythematous macular papular rash over the right upper shoulder, face and chest. It was noted to be less red than yesterday's description and was responding to treatment. The pt was otherwise noted to be healthy and in apparent distress. On that same day the pt was vaccinated SC with a second dose poliovirus vaccine inactivated (Ipol) (lot W0704), a second dose given IM of diphtheria toxoid (+) pertussis acellular Biken vaccine (+) tetanus toxoid (Tripedia) (lot U0853DA), a second dose given IM of Hib conj vaccine (tet toxoid) (lot UA827AA), and a second dose given IM of pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (CRM197) (Prevnar) (lot 492806). It was also reported that the parents and infant would be traveling and that the pt's would drop off a stool sample prior to their trip. Additional information has been requested. It was also reported that the pt's mother was vaccinated with a of dose varicella virus vaccine live during her pregnancy.