Age: 7.0
Sex: F
Vaccine: FLU4, PPV, FLU3, PPV, FLU3, PPV
Symptoms: Injection site cellulitis, Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: This spontaneous report as received from a physician via a company representative refers to a 7 year old female patient with asthma and drug reactions/allergies to morphine (manufacturer and dose/frequency unknown). The patient's medical history included previous case of pneumonia. On 04-OCT-2013, the patient was vaccinated with PNEUMOVAX23 lot # H015780 exp date 11-JUN-2014, in the right arm (dose and route not reported). On 04-OCT-2013, concomitantly was vaccinated with FLUZONE 0.5 ml, in the right arm, with different injection sites. On 04-OCT-2013, the patient mother called the physician and stated that her daughter's arm was swollen. The physician advised to ice the arm and take MOTRIN (unspecified dose and frequency). On 06-OCT-2013, the patient visited an unspecified emergency room and was treated for potential cellulitis and low grade fever with SEPTRA (unspecified dose and frequency). It is unknown whether the patient was admitted to the hospital. At the time of the report the outcome of the events was not reported. Additional information was received from medical records concerning a 7 year old female, who on 04OCT2013 was vaccinated with a dose of PNEUMOVAX23 lot # H015780 exp date 11JUN2014 in her right deltoid (also reported as left deltoid) at 0945. The patient has a morphine allergy, asthma and past medical history of pneumonia, and lung empyema with surgery. Concurrent medications include SINGULAIR, ZOFRAN ODT, PROVENTIL, azithromycin, FLONASE. On 06OCT2013, the patient presented to the hospital with her mother for evaluation of redness and swelling to her right arm. The patient's mother stated that approximately three days ago the patient developed a cough and congestion and was seen by her pediatrician. Due to the patient's history of developing pneumonia and a empyema, the patient was placed on azithromycin and at the same time was given immunization shots in the right arm consisting of FLUZONE and pneumonia vaccine. The next day the patient developed a localized area redness and also developed a fever of 102F. On 06OCT2013, a small area of redness had progressed rapidly and she was seen. The patient was placed on amoxicillin and SEPTRA for potential cellulitis and her mother was told to return if the patient had worsening of symptoms. The patient had continued with low grade fever and her mother administered albuterol by small volume nebulizer (SVN) at home prior to coming to emergency department. On examination the patient was awake, alert and interacted appropriately, temperature 100 F. There was diffuse erythema, edema, warmth over the deltoid area with extension of the erythema outside the borders of pen emargination. Laboratory results included the following: white blood cell (WBC) 10.1, sodium 129, blood urea nitrogen (BUN) 7. Blood culture was drawn and showed no growth after 5 days. The patient was admitted for further monitoring, treatment and care. The physician felt the patient required IV antibiotics, and clindamycin 10mg/kilogram was ordered. Physician impression, patient with acute cellulitis of right upper extremity and acute upper respiratory infection. The patient was admitted for further monitoring, treatment and care. On 08OCT2013, immunoglobulin G result 1330 and white blood cell (WBC) 11.2 and platelet count 375. It was noted that patient was discharged on 09OCT2013. At the time of this report it was noted that the patient had recovered on 16OCT2013. All available medical records will be provided upon request. Additional information has been requested.