Age: 4.0
Sex: F
Vaccine: DTAP, IPV, MMR, VARCEL
Symptoms: Cellulitis, Injection site pain, Injection site swelling, Injection site warmth, Pruritus
Clinical narrative: Info has been received from a physician concerning a 4 year old white female with asthma and unspecified allergies (also reported as NKDA), who on the morning of 5/13/05, was vaccinated, SC (also reported as IM) with a dose of MMRII (lot 649006/0554P). Concomitant therapy given SC, included a dose of varicella virus vaccine live, an IM dose of Tripedia (batch 345BA) and an IM dose of poliovirus vaccine inactivated (Vero) (IPOL) (batch Z1006-2). All of the vaccines were administered into the anterior lateral thigh (not the medial aspect as previously reported). There was no other concomitant medication. At the time of vaccination, the pt had several "bumps" on both her legs and arms, that have been there for 3 weeks. The pt's mother said the bumps were pruritic and that they were insect bites. The pt was treated with Hydrocortisone Ointment, apply TID, PRN and Benadryl prn for the insect bites. The pt was afebrile and had the same activity level. A physical exam was also performed and the following were reported as normal; ear discharge, sinus  (nose), uvula, thrill of heart, adventitious lung sounds and Romberg neurological. According to a 2nd physician on 5/29/05, the pt's mother called and reported that the pt was complaining of right leg pain with ambulation, which she felt was related to the prior injections received. At approximately 14:30, the physician personally went to the pt's day care center to assess the pt. A circular area of redness was noted on the pt's inner medial aspect of the left proximal thigh. The area was warm, slightly swollen, and moderately tender with palpitation. The pt was dx'd with cellulitis. The physician also noted that she had insect bites in various stages of resolution on her arms and legs that had been previously noted on the day of vaccination. The pt was treated with Keflex X 7 days and an (illegible) cream, and warm compresses to the affected area. The physician notified the pt's mother of the recommendations and findings. The physician also noted that he was never notified by the previous reporting physician or facility of any other adverse events (i.e. rash or wheals). The physician also noted that the vaccine lot had been completed without any other known issues. It was noted that a prescription that had been called in on 5/29/05 for the pt was not picked up. On 7/23/05, the physician's office spoke by telephone with the mother. Per the pt's mother, on the night of 5/13/05, the pt couldn't walk. The pt's mother stated a few days later, she 1st got a rash and it started spreading, then she had "2 bumps" on her leg. On 5/29/05, when she (mother) noticed that the rash was spreading, she called the doctor's office. The pt's mother complained of redness on her daughter's left thigh. That day, the physician personally visited the pt's day care center to assess the pt. The pt's mother was told that it was a staph infection. It was noted that "she wasn't confident about that" so she took the pt to an ER pediatrician who told her that the varicella virus vaccine live was "given wrong". The pt's mother stated that she has been a medical assistant for years and knows that the varicella virus vaccine live is to be administered SC, however, she was too busy comforting her crying child to notice how it was given. It was noted on 5/29/05, the mother's office was not aware if the pt suffered from any adverse reaction to the vaccines. The pt was seen on 5/29/05 and there weren't any new lesions. There was a small area of cellulitis on the left inner thigh. There were no adverse events following prior vaccinations. Subsequently, the pt recovered. Additional info is not expected.