Age: 0.5
Sex: M
Vaccine: HIBV
Symptoms: Irritability, Lymphocyte percentage increased, Mean cell haemoglobin, Mean platelet volume increased, Nasal congestion
Clinical narrative: Information has been received from a physician via pediatric medical records concerning a 6 month old male patient who on 03-SEP-2208, received a fourth dose of Hib conj vaccine (manufacturer unknown), a first dose of MMR II. On 18-MAR-2009, the patient received a first dose  VARIVAX and a first dose of VAQTA. Concomitant vaccination included a dose of DTP, a fourth dose of PREVENAR and a dose of influenza virus vaccine (unspecified). It was reported that on 26-Feb-2008, the patient presented to the physician's office with "pulling at his right ear", some mild nasal congestion and a slight cough. The baby's physical examination resulted in normal however his nose was congested with clear nasal drainage. The physician's impression was upper respiratory tract infection. The patient was placed in symptomatic treatment and scheduled for follow-up as needed. On 27-MAR-2008, the patient presented to the physician's office with complaints of cough and congestion over the past month that had slowly gotten worse. The patient also had a spot on the right lateral border of his mouth that had been slowly getting larger. It did not seem to be itching and did not seem to bother the patient. The physician reported that the baby had an approximately 1.5 cm circumferential lesion at the right lateral border of the mouth. There was some yellow crusting on the lesion. The physician's assessment was sinusitis and impetigo. The patient was given a prescription for Amoxicillin 400 mg per 5 ml to be given 6 ml BID for 10 days. The patient was also given BACTROBAN ointment to apply TID for 7 days. There parents were instructed to continue symptomatic treatment as needed. On 21-Apr-2008, the patient was seen by the physician for evaluation of some rash that was coming and going especially on his face over several weeks. It nearly cleared with oral antibiotics but not completely. Some topical antibiotics did not seem to help very much. Examination on that visit did show some reddish, scaling areas on his cheeks that the physician thought represented some eczema changes. The baby had a background of some dryness at other locations as well and the physician thought it had become impetiginized on a few occasions and th oral antibiotics had helped with this, but the background dermatitis persisted. The physician also recommended a salicyclic acid shampoo to be used for a localized are of cradle cap. On 23-APR-2008, the patient was seen for some diarrhea after completing a course of ZITHROMAX. The physician suggested MYCOLOG cream to be applied twice a day. The patient had developed a diaper rash that had been going on for nearly two weeks since that visit. The physician reported that the baby had a mildly red papular diaper rash without areas of coalescence. On 29-APR-2008, the patient's baby was at the office for the diaper rash that had gotten significantly better with treatment with nystatin. Mother said that the area had been going on for nearly 2w weeks and had begun to bleed and she was worried that there may be a secondary infection. The mother also did say that the patient's diarrhea had begun to slow down over th past day since that office visit. The physician's assessment was a diffuse diaper rash some which appeared candidal, but the rest appeared to be contact dermatitis. The patient's mother was instructed to continue using the nystatin as prescribed. On 14-MAY-2008, the patient presented to the physician's office after falling from a high chair. He slopped out of the high chair and apparently hit his head on the floor. He cried right away. He had no vomiting, was alert and oriented. The had no sleepiness or other systemic complaints. The physician's impression was fall with  no evidence of significant injury. On 11-Jul-2008, the baby was at the physician's office with a low-grad temperature last night of 99.2. The baby had been pulling at his ears and had some mild nasal congestion, a slight cough but no vomiting or diarrhea. The baby had been "fussy" and also had four papular lesions developed on his abdomen that the patient's mother was worried about being chickenpox. Physical examination revealed that the baby was congested with a yellowish nasal drainage and presented several red papular lesions without evidence of vesicular formation. The physician's impression was viral illness with viral exanthem. ON 20-AUG-2008, the patient presented to the physician's office after he burned his right hand on ring and middle fingers of the left hand. Physician's impression was small second degree burns. Local care instructions were given. On 03-SEP-2008, laboratory test were performed and revealed mean corpuscular  hemoglobin concentration: 38.7 %; blood platelet count: 505 1000/uL; mean platelet volume: 10.1 fL (increased); blood lymphocyte count: 73 %; blood neutrophil count: 16 %. It was reported that on 09-SEP-2008, the patient had an intermittent temperature of up to 101. He had had no other systemic complaints other than some red spots that have developed over the last two days. Physical examination was within normal limits with exception of a skin examination, which revealed approximately a dozen red popular lesions located on the upper part of both arms and around the back of the neck. The physician's impression was: insect bite. Instructed to treat symptomatically. On 02-MAR-2009, the patient presented to the physician's office with fever of up to 102.6 over the past three days. Temperature defervesced with Acetaminophen. The patient had had mild nasal congestion with some clear to yellowish nasal drainage. The patient's mother denied any symptoms of sore throat or dysphagia. Physician's impression was viral illness and th patient was scheduled to follow up for persistent or worsening symptoms. On 18-MAR-2009 the patient's mother reported to the physician's office that the patient had hayfever for 2 weeks. On 19-MAY-2009, the patient presented to the physician's office with the onset of fever that afternoon of up to 103.5. The patient was given Acetaminophen and his temperature decreased somewhat. The patient had on diarrheal stool on the same day of the visit. Physician's impression was: viral illness. On 30-MYA-2009, the patient present to the physician's office because he had been coughing up greenish/yellowish phlegm for a week. The patient was on Zyrtec and Tylenol. Physical examination was normal except for the nose with thick yellowish rhinorrhea. Physician's impression was nasopharyngitis. No further information was available.