Age: 67.0
Sex: F
Vaccine: PPV
Symptoms: Blood urea nitrogen/creatinine ratio decreased, C-reactive protein normal, Chest discomfort, Colonoscopy abnormal, Computerised tomogram abdomen normal
Clinical narrative: Information has been received from a physician concerning a female patient with drug reactions/allergies and medical history unspecified, who was vaccinated with 0.5 ml dose of PNEUMOVAX 23 (date, dose and lot number not reported). The physician reported that on an unspecified date, the patient experienced redness and swelling after receiving PNEUMOVAX 23 vaccine and it was hot the touch. There were some knots in the area of the injection site (date unspecified). At the time of the report the outcome of the patient was unspecified. It was unspecified if the patient sought medical attention. Follow up Information has been received via medical record. The physician reported that a 68-year-old woman with abdominal pain, shoulder pain, hiatus hernia, gastritis, gastric polyps, diverticulosis, haemorrhoids, hypertension, chronic back pain, bone development abnormal, muscle soreness, pollen allergy, house dust allergy, rhinitis allergic, chronic anxiety, depression, anaemia, non-smoker, nasal septum deviation, nasal sinus discharge, nasal obstruction, oesophageal reflux, vitamin b12 deficiency, diabetes, liver fatty, adhesive tape allergy, heart enlarged and eyelid ptosis and a history of gravida 1, para 1, diarrhoea, nausea, stools absent, bowel movement irregularity, gastric hypomotility, abdominal discomfort, hysterectomy (in 1969), explorative laparotomy (in 1975), temporomandibular joint syndrome (TMJ) (in 1986), cervical discectomy (in January 1999), which required a fusion with platelet and screws 2 months later, skull plate internal fixation, defective screw, colon adenomatous polyp, constipation, bloating, dysphagia, headache, nasal congestion, hoarseness, post nasal drip, rhinorrhoea, sore throat, ear pruritus, chest discomfort, swelling, surgery, surgery, surgery, dizziness, tinnitus, swollen glands, haemorrhoidectomy, oesophageal stricture, ganglion cyst and watering eyes who on 24-MAY-2010 was vaccinated IM with a second dose of PNEUMOVAX 23 in the left arm (Lot number: 664864/1365Y). It was reported that there were no illness at the time of vaccination. Concomitant therapy included AMITIZA, NEXIUM, SOMA, acyclovir, allergenic extract and cyanocobalamin. On 26-MAY-2010, the patient experienced redness, swelling and tenderness at the injection site after receiving PNEUMOVAX 23 vaccine and it was hot the touch. There were some knots in the area of the injection site. There was an area of erythema and increased warmth on the inner left upper arm. She had tenderness of the anterior left shoulder, which is a recurrent problems with her. There was some tenderness in the outer upper left arm and over the shoulder.  The physician felt this was a reaction to the PNEUMOVAX 23 vaccine. There do not seem to be evidence of a cellulitis. The physician told her to use warm soaks and to call if worse. The patient said that since then she has had dysesthesias and numbness in the left hand, particularly in the median nerve distribution. She also had some left hand weakness. At the time of the report the outcome of the patient was recovered over next two weeks (09-JUN-2010). On 12-JUN-2010, the patient had a colonoscopy for blood in stool and personal history of colon polyps results were reported as a polyp in the proximal ascending colon (polypectomy), diverticulosis of the sigmoid colon, internal and external hemorrhoids. Otherwise normal colonoscopy to cecum. On 19-JUN-2010 and 21-JUN-2010, doctor visits were performed and the patient admitted with a  2-day history of diarrhea, nausea, and abdominal pain. The patient says she did not have a bowel movement for 2 days and took some MIRALAX and has been sick ever since with constant liquid diarrhea to the point that she has rectal pain. She had not been able to keep anything down and has developed progressive dry mouth and thirst. She had had problems with gastric hypomotility and had been evaluated over the past 6 months by other physician. So far, attempts at treatment have not been successful. Upper endoscopy and colonoscopy have not revealed any distinct abnormality. She has had CAT scans and ultrasounds of the abdomen, which also were not revealing of any particular pathology. The patient did respond somewhat to REGLAN, but she had extrapyramidal side effects and this was discontinued in August 2009. The patient had been on the CARAFATE and a PPI and this was changed to a higher dose of NEXIUM twice a day. She was placed on AMITIZA 24 mcg twice a day in April 2010 by other physician. He told her to stop CARAFATE. The patient has bitterly complained of her abdominal and chest discomfort and the main thrust of her request is that she feels better and the nothing has worked. On 19-JUN-2010 an abdomen/KUB was performed and the pattern was normal. On 20-JUN-2010 an abdominal aorta artery ultrasound and showed no evidence of a significant abdominal aortic or visceral vessel disease. The discharge of Diagnosis for the first Doctor was Acute gastroenteritis resolved, hypertension, B12 deficiency and dehydration resolved. On 23-JUN-2010, the discharge summary for the second Doctor was the following: Physical examination revealed uncomfortable soft spoken and the review of the systems were normal except: Abdominal examination that the abdomen was soft quiet mildly tender. Neurological examination that the results showed there was a decreased sensation in the left, first second and third fingers. There was positive Tinel's. She was some what hysterical about all of this and was difficult to determine the sensory examination. There was a resolving ecchymotic area in the left upper arm. Reflexes were symmetrical. There was decreased grip in the left upper arm. She kept her hand flexed around the bed rail it was very difficult, examination, there seem to be decreased grip on the left. The patient was placed on IV fluids and consultation was requested. BUN was 9, creatinine 1.0, alkaline phosphatase slightly elevated at 149, SGOT is normal at 13, potassium was 3.0 and she was given potassium supplements. Hemoglobin 13.6, white count 4.2, platelet count 242,000. Sedimentation rate 18. CRP was 6.1 which is slightly elevated but still within the normal range. On June 20, a KUB was normal. She did complain of pain "in my bottom" and did have tenderness in the coccygeal region. The patient wanted to be placed back on REGLAN even after discussing the possible side effects and what had happened to her previously. A mesenteric Doppler was done which was normal. She continued to have some nausea and pain on the 22nd. Her chest was clear. There is a regular rhythm. The abdomen was soft and non tender. Calves were also soft. A nuclear gastric emptying study was done, which was also normal. The patient continued to thread about her lack of bowel movements but wanted to wait until she got home before she started taking her MIRALAX. By the morning of the 23-JUN-2010, she was afebrile. The patient claimed she was no better; however, she had much less abdominal pain much less diarrhea and almost no nausea. Certainly, it is possible she might benefit from antidepressants, but "She will have to admit that depression is a major factor in her illness before something can be done about it. I was encouraged by the normal gastric emptying study; however, her prognosis is poor because of her endless complaints about one thing or another, most of which have to be checked or treated". Additional information is not expected.