Age: 1.2
Sex: M
Vaccine: VARCEL
Symptoms: Mental status changes, Oxygen supplementation, PCO2 increased, Respiratory acidosis, Respiratory rate increased
Clinical narrative: Information has been received from a physician concerning an 18 month old male with asthma who at 12 months of age was vaccinated with a dose of VARIVAX.  Subsequently, he developed herpes zoster consisting of vesicular lesions on the right side of his scalp.  At the time of the herpes zoster, the patient was on low dose steroids.  A specimen was submitted through the VZV ID program for PCR analysis.  Results are pending.  No outcome was reported.  Additional information has been requested.  Information has been received from a physician concerning an 18 month old male with a history of bronchiolitis and reactive airway disease who on 16-JAN-2008 was vaccinated with a first dose of VARIVAX (lot #654413/1140F) in his right thigh.  On 04-MAY-2008 the patient presented with a 1 day history of increase work of breathing, wheezing, gasping for air, and increased agitation.  On the same day, he received albuterol 6 times without improvement.  He was taken to emergency department.  It was reported by the mother that the patient had been treated with albuterol approximately for the last 2 months.  In ED, the examination showed that his respiratory rate 70, Sats 70%, abnormal mental status, increase agitation, s/p Solumedrol 2 mg/kg and Mag. CXR: hyperinflation with no focality.  Initial venous blood gas 7.1/80.  He was placed on continuous positive airway pressure without improvement, increasing lethargy.  Terbutaline drip started.  VBG 7.2/6.1.  Racemic epi 2 times without improvement.  Preintubation gas 7.06/88.  He was intubated and transferred to pediatric intensive care unit.  The patient was admitted to the pediatric intensive care unit from 04-MAY-2008 to 13-MAY-2008.  He was intubated, he was treated with Terbutaline drips, albuterol, solumedrol versed, ketamine Vec drips, heliox was 80/20.  Persistant poor ventilation with consistent respiratory acidosis (PH 6.9, pCO=116) led to extracorporeal membrane oxygenation V/V cannulation.  On 05-MAY-2008, ECMO was off, intravenous fluids Zantac, total parenteral nutrition started.  Cardiac examination showed that heart disease was stable and echo showed good function.  After decannulation he developed some respiratory acidosis which responded to vent changes and mild hypotension (60's - 30's).  On 07-MAY-2008, terbutaline and ketamine discontinued and low dose epi weaned to off.  The patient started feeds via normal delivery.  On 08-MAY-2008 terbutaline restarted but magnesium was stopped.  On 09-MAY-2008 the patient was Extubated to bilevel positive airway pressure.  Aminophyline and terbutaline discontinued.  On 11-MAY-2008 the patient went from BiPAP, to CPAP, to room air and started activan/methadone taper and oral route feeds.  On 12-MAY-2008 ZOSYN completed and blood cultures were negative.  On 16-MAY-2008 some red macules appeared on his scalp.  On 19-MAY-2008 the patient was sent to ER and found about 20 vesicles around right vertebral 1 dermatome area.  A specimen was taken from a vesicle and submitted through the VZV ID program for PCR analysis.  On 19-MAY-2008 the source of the specimen was a vesicle and the patient was taking ACV 20 mg/kg/dose once a day.  On 23-MAY-2008 the patient reported to the physician via phone that all lesions crusted, no new lesions.  At the time of the herpes zoster, the patient was on low dose steroids (from 04-MAY-2008 to 23-MAY-2008).  On 29-MAY-2008, VZV identification program result showed that the VZV strain is vaccine strain.  Additional information has been requested.