Age: 1.04
Sex: M
Vaccine: HIBV, MMR, VARCEL
Symptoms: Conjunctivitis, Herpes zoster, Pyrexia, Viral infection
Clinical narrative: Information has been received from a RN concerning a 7 year old male with nkda, medical Hx, or Hx of chicken pox who on 11/03/1997 was vaccinated SC in the right arm with a first dose of varicella virus vaccine, live. Concomitant medications on the same day included a SC first dose in the left upper arm of measles virus vaccine, live, + mumps virus vaccine, live+ rubella virus vaccine live, and an IM 4th dose in the left lateral thigh of Hib conjugate vaccine (OMPC). There was no known illness at the time of vaccination. The pt's vaccination record indicated that on 10/20/1996, the pt was vaccinated with a first dose of Hep B virus vaccine rHBsAg (yeast). On 12/16/1996. he received an IM first dose in the left thigh of diphtheria toxoid + Hib conjugate vaccine + pertussis whole cell vaccine + tetanus toxoid, a first dose of oral poliovirus vaccine, inactivated, and a second dose in the right thigh of Hep B virus vaccine rHBsAg. On 02/24/1997, he received an IM second dose in the right thigh of diphtheria toxoid + Hib conjugate vaccine + pertussis whole cell vaccine + tetanus toxoids, and a dose of oral poliovirus vaccine inactivated. On 04/28/97, he received an IM dose in the left lateral thigh of diphtheria toxoid+ Hib conjugate vaccine + pertussis whole cell vaccine + tetanus toxoid, a dose of poliovirus vaccine inactivated, and an IM dose in the right lateral thigh of hep B virus vaccine rHBsAg, the pt received an IM dose in the right arm of diphtheria toxoid + pertussis vaccine+ tetanus toxoid. The pt received an IM dose in the right arm of diphtheria toxoid + pertussis vaccine+ tetanus toxoid, he received an IM dose in the left arm of diphtheria toxoid + pertussis vaccine + tetanus toxoid, a SC dose in the arm  of measles virus vaccine live + mumps virus vaccine live, + rubella virus vaccine, and an ID dose in the left forearm of tuberculin purified protein derivative. On 10/25/2000, the tuberculin purified protein derivative injection was read at 0mm. On 11/20/2000 he received an IM dose in the LDT of pneumococcal 4 6B 9V 14 18C 19F 23F conjugate vaccine. The reporter indicated that beginning on 03/01/04. the pt's left eye red, clear discharge, nasal congestion, and fever. ON 03/13/04, "skin lesions scalp, neck, and left wrist. Medical records indicated that on 03/15/04, it was noted that the pt was brought into the office by his mother with complaints of the left eye being red for the past two weeks. Clear discharge was present but on 03/14/04, the eye was worse according to the mother. Nasal congestion  and fever was noted. No temp was recorded by the mother and no vomiting or diarrhea was noted. The mother also noticed skin lesions on his scalp, neck, and left wrist since 2 days ago. Itching was present. There were no medications. His O2 sat. in the office was 97 percent. His T was 98.8, weight 73 Lbs. P 115 BPM, R24 B/P 102/62. Tympanic membranes were normal and his throat was clear. Eyes, left sclerae markedly injected. No discharge noted. No swelling. Extraocular muscles intact bilaterally. No significant lymph nodes enlarged. Cardiac no murmur, lungs clear, abdomen soft, no hepatosplenomegaly. Skin erythematous. Papules, vesicles, and pustules were present, one on the left wrist, scattered on the chest, abdomen, and back and scalp. One vesicle noted behind the right pinna. Scattered erythematous pustules were present on the lower extremity. Marked itching was present. No lesions were seen on the palms and soles of feet. CNS, no neck rigidity. Pt appeared very alert and active in the office. The assessment was conjunctivitis, chicken pox. The plan included polymyxin B sulfate + trimethoprim eye drops, one drop each eye, TID x 5 days. The DX was discussed at length with the mother. Diphenhydramine hydrochloride (Benadryl) was to be used every 6-8 hours PRN for itching. Calamine lotion, acetaminophen (Tylenol), no ibuprofen, and plenty of fluids. The mother was to observe the lesions. Follow up if any change in symptoms was noted. Medical records indicated that on 03/18/04, the MD spoke to the CDC regarding the pt's lesions which were questionable chicken pox. Since the pt was vaccinated at 12 months of age with varicella virus vaccine live, the MD was told to send a sample of the lesion taken with the curette to the CDC to be cultured to see whether it was a wild varicella or if it was varicella at all. The mother was instructed to come into the office to get a sample of lesions, on crusted and  one pustular to be sent to the CDC. The mother was informed that she would be notified of the results. Two swab cultures were obtained on 03/21/04 and submitted to the CDC. On 03/26/04, it was reported that both swabs were adequate specimens that were positive for varicella zoster virus wild type. Chicken pox was confirmed by the CDC, Subsequently, the pt recovered. It was noted that the pt had no adverse events following prior vaccination. No further information is expected.