Age: 66.0
Sex: F
Vaccine: FLU3, PNC13, VARZOS, FLU3, PNC13, VARZOS
Symptoms: Injection site erythema, Rash macular
Clinical narrative: Friday 11/18/2016 1:43-2:07PM at pharmacy, I received following vaccines: FLUZONE High Dose 2016-17 0.5ml SYR Lot # UI703AA in upper right arm IM, PREVNAR 13 0.5ml Lot # N34935 in upper left arm IM, ZOSTAVAX Inj. single dose vial Lot # M634765 in upper right arm SUB Q beneath FLUZONE injection. Saturday 11/19/2016 at approximately 6:00 AM, woke to find upper right arm inflamed about 1inch in diameter around ZOSTAVAX site, with itching and tenderness. I assumed this was a normal reaction. Sunday 11/20/2016 at approximately 5:45 AM woke to find upper right arm was bruised, swollen, hot, painful, itching and inflamed about 2.25 inches in diameter around the ZOSTAVAX site, and blotching near the FLUZONE site. I went to the ER at approximately 7:00 AM, and was initially diagnosed as having an allergic reaction, with the possibility of an onset of a bacterial skin infection. I was prescribed BENADRYL capsules 25 mg OTC to be take right away, and Cephalexin 500mg Q6H and Sulfameth/TMP 800mg/160mg to be taken if the inflamed area grew beyond the area marked on my upper right arm by the PA-C. I was told if the redness and swelling continued to worsen, to begin the antibiotics and return to the ER for evaluation. Monday 11/21/2016 at approximately 7:30AM returned to the ER. Upper right arm swollen, painful, itching and the inflammation had grown to about 3.5 inches in diameter around the ZOSTAVAX site, and continued to blotch and become more inflamed near the FLUZONE site. The greater inflamed and swollen area marked again by the PA-C. I was diagnosed with cellulitis and given and IV infusion of Vancomycin for approximately 3 plus hours, told to begin the oral Cephalexin and generic BACTRIM when I got home, and to return to the ER at 10:00 PM that evening for another IV infusion of Vancomycin. Monday 11/21/2016 at approximately 10:00 PM returned to ER as directed and received a second IV infusion of Vancomycin, told to continue the oral antibiotics as prescribed, follow-up with my PCP, and return to the ER for a follow-up evaluation on Thursday AM 11/24/2016 unless condition worsened. Tuesday 11/22/2016 at 11:40 AM follow-up with CNP at PCP office. Condition of upper right arm had not worsened. I was told to continue with Cephalexin and generic BACTRIM, and return for re-evaluation on Tuesday 11/29/2016 at 9:40 AM. Thursday 11/24/2016 at approximately 7:00 AM returned to the ER for re-evaluation. Condition was improving, I was told to continue with Cephalexin and generic BACTRIM, was prescribed an additional 3 days of Cephalexin, and told to continue the follow-up with my PCP. Friday 11/25/2016 continued oral antibiotics. Condition improving. Swelling,  fever and redness reduced to 2.25 inches in diameter around ZOSTAVAX site. Saturday 11/26/2016 condition improved. Swelling and redness reduced to 2 inches in diameter around ZOSTAVAX site. Sunday 11/27/2016 condition improved. Swelling and redness reduced to 1.5 inches in diameter around ZOSTAVAX site. Tuesday 11/28/2016 at 9:40 AM follow-up with CNP at PCP office. Swelling and redness reduced to 1 inch in diameter around ZOSTAVAX site. Prescribed an additional 7 days of generic BACTRIM, and told to return for evaluation on Monday 12/05/2016 at 8:40 AM. Monday 12/05/2016 at 8:40 AM review by CNP at PCP office. Continue with generic BACTRIM until gone. No further follow-up is necessary.