Age: 0.51
Sex: M
Vaccine: DTAP, HIBV, PNC, DTAP, HIBV, IPV, PNC
Symptoms: Pallor, Pneumothorax, Pupils unequal, Pyrexia, Respiratory failure
Clinical narrative: I am the mother of the child at the center of this case. He is a three year old boy who was born full-term with no complications.  He was a very healthy baby until he turned six months old.  My belief is that he would not have fallen so ill had he not received his six month vaccinations.  He was diagnosed with an upper respiratory infection, when in fact he had Type A Flu.  Where my confusion lies, is that I specifically asked the nurse practioner who saw him that fateful day, not to give him his vaccinations.  I knew he was not feeling well and was possibly coming down with the flu.  My two older children were sitting in the very same room when she diagnosed them with the Flu.    My belief is that his immune system was overburdened to the point of not being able to handle building up the anti-bodies from the vaccinations he was given and to fight off the Flu that he had!  Could he have avoided all the complications had he not received those vaccinations?  Upon reviewing his shot records, one of the vaccinations, The DTap, DT, or DTP administered on 12-8-03 shows to have expired in 2001!  It is not clearly stated on the shot records which one he received.  Why was an expired vaccination administered to him that day?  I was exhausted from caring for my other two very sick children for several days and fighting off the flu myself.  I asked on 2 occasions not to administer his shots; however, she confirmed and insisted that everything would be okay.  Being a mother and not a doctor, I instilled my trust over to her.  After all she is the physician and I am not.  I can't help but to wonder if his situation would have turned out differently had we waited until he was 100% healthy before he received his vaccinations.    Below is a chronological description of his health situation.  12-8-03 (Monday) My youngest son had his six month well-check with a nurse practioner.  I took him to his appointment around lunch time thinking he would not receive his vaccinations, but hopefully to catch his illness that seemed to be coming on that morning.  I feared it was the flu like my other two children were suffering from.  I took all three of my children to the pediatrician's office to get looked at.    While there, the nurse practioner saw us.  My three children and I were all in the same room waiting for him to be seen.  NP diagnosed my other two children with the flu.  As she began to look at my son and ask the well-check questions, she asked if I had any concerns.  I replied that I thought he was not feeling well and starting a very dry cough that morning.  I did not want him to have his shots.  She said it would be okay.  I expressed my concern and she again reassured me that it would be okay and she said, "I'll even take his temperature again."  She said he did not have a fever at the time and that he would be just fine. He was given 4 vaccinations that day, the Prevnar, DTap, IPV, and the HIB 3.  I brought him home, gave him a dose of Tylenol for the vaccination pain and put him down for his nap. He napped for about four hour's long- a very long nap for him.  He awoke late that afternoon and was running a very high fever.  I was very concerned and mentally planned to stay up with him all night.  By around 9:00 pm that evening I was extremely concerned for him.  His fever was above 103 and he was extremely irritable and fussy.  He was crying uncontrollably. I called and spoke with a triage nurse.  I stated that his fever was too high from having vaccinations.  She stated it was from the vaccinations recommended that I alternate Motrin and Tylenol every three hours.  I gave him a dose of Motrin and after 30-45 minutes his fever was down but it was still 102.7 degrees.  I then called the  Urgent Care Clinic.  They said that if I was concerned I should take him to the emergency room.  I felt that I could not leave my other two sick children and also I did not know how to drive there, especially by myself at night.    He grew worse over the span of the night.  It seemed to me that he was not breathing right.  He would only stop crying if he was lying on my chest.  His breathing sounded worse.  I gave him breathing treatments with a nebulizer at home to try to help him.    Early the next morning I called my sister-in-law with a desperate plea.  She came immediately over and I had him in his car seat ready to go straight back to my pediatrician's office.  My sister in law had to stay with my other two children because they were still so sick from the flu.  I waited in the waiting room, but on the inside I wanted to charge through the doors of the doctor's office.  They brought us back fairly quickly and the doctor was not yet in the office.  Another doctor and nurse looked and patient and immediately put the device on his toe to measure his blood oxygen levels.  I remember that his levels were below 90, the were 88.  They gave him breathing treatments and he was still not consolable.  The doctor came in and immediately called for a transport to take him to the hospital.  My husband left work and met me at the doctor's office while we were waiting for the ambulance to arrive.  The ambulance arrived and they worked on him several minutes before taking him to the hospital.  My husband rode with him in the ambulance and I drove home to inform my sister-in-law of what was happening.  I contacted my sister and parents and begged for some support.  I then drove to the hospital and went to the emergency room where the immediately escorted me to where my son and my husband were.  They had just intubated him and he seemed at peace at last.  We walked upstairs with him as they transported him into the PICU unit.  Then we answered the initial questions they asked for his medical care and history.  My husband spent the rest of the day, all of that night and all of Wednesday in the hospital.  He was able to learn and explain to me what all the monitors meant.  During that time I was back and forth between home and the hospital trying to make arrangements for care for my other children.    He stayed incubated in PICU from Tuesday, 11-9-03 through Wednesday 12-10-03.  By Wednesday evening he had improved to the point that they extubated him late that night.  My husband and I were both there during this process.  The extubation seemed a success.  12-11-03 (Thursday) my husband by this point was so exhausted that he too fell ill and had to go home and rest.  He was released from PICU but remained there because there were no beds available in the hospital yet.  12-12-03 (Friday)  It seemed to me, on this day, that he was not doing well.  But because he had been so sedated during his intubation I did not know what to expect.  But looking back, he was actually starting to seize as his eyes rolled from side to side.  I just thought he had a bad headache and did not feel well. He was lethargic and his color was ashen.  He barely would cry, and when he did, I was told that his throat was sore from being intubated.    12-13-03 The doctor rescinded his order to be released from PICU that day and some stats did not seem to make sense to him.  I received a phone call somewhere between 2:00 and 3:00 am and his nurse explained he was having some complications and they needed to place a chest tube in him.  I consented.    12-13-03 (Saturday)  He was in dire condition and they were running tests to see what was wrong.  They began discussing a procedure called ECMO and warned us that they did not even know if he would survive the procedure.  Amazingly enough, he did stabilize as the ECMO team stood around him ready to go.  They found meningitis bacteria in his spinal tap and bloodstream that night.  We were told he might not survive the night because his brain was swelling at such a rate and there was nothing they could do for that.  Also during this time period once he was stabilized they took him down stairs for a CT Scan.  The doctors reported  that it was a dirty picture.  Meaning there was brain damage.  During this time he completed a 21 day period of rocefin which was the antibiotic used to battle the meningitis bacteria.    During this time he became dependent upon several of the drugs administered to him.  As they were weaning him off these drugs, it was very difficult to watch this 6 month old baby going drug addiction withdrawals.  He still required the placement of another chest tube in his side due to a pneumonthorax in one of his lungs.      Until recently when I had help looking through his medical records, I thought his main problem was the meningitis.  Besides battling Influenza A and pneumococcal meningitis, healso was battling Strep pneumonia meningitis and bactermia with associated septic shock and severe pulmonary dysfunction Thrombocytopenia, and severe encephalopathy, respiratory failure secondary to Influenza A, Spontaneous pneumothorax on the right side under tension,   On January 2, 2004 he was transferred from PICU to a regular hospital room on the infectious disease unit of the hospital.  He stayed in that room from the 1/2/04 through 1/14/04.  The following is a list of events that occurred during his stay in this unit of the hospital; 1. He continued to go through the narcotic withdrawals. 2. Two hearing tests were performed on him which showed a several to profound hearing loss bilaterally.  We were told that he would be a great candidate for Cochlear implants. 3. He began to eat a few bites of solid food (rice cereal) but did not drink from a bottle. 4. A G button was surgical placed in his tummy for his formula intake. 5. His right eye was wondering and we began seeing a Pediatric Eye Specialist. 6. He under went  physical therapy for severe torticolis and therapy for other concerns throughout his body. 7. He under went occupational therapy for reasons listed above. 8. The infectious disease specialists did a work up of hi's immune system.  The results showed his immune system to be normal.  However, they only performed tests for the pneumococcal vaccination and did not perform testing of his immune system for the other vaccinations that he received on 12-8-03.  Again, a work up was not done for the DTaP vaccination which is the vaccination in question. 12/19/16-records received and reviewed DC Summary DC DX: Status post influenza A infection/croup Status post pneumococcal sepsis/meningitis/septic shock Chronic subdural effusion secondary to meningitis Central nervous system stroke/infarcts versus acute demyelinating encephalomyelitis. Seizure disorder Status post right pneumothorax with chest tube Right cranial nerve III injury with strabismus and anisocoria Narcotic benzodiazepine tolerance/dependence, resolved Feeding issue, status post percutaneous eddoscopic gastrostomy placement 1/8/04. hearing loss bilaterally candidate for cochlear implants Serous otitis media bilaterally, resolving Hypnotonia.  Previously healthy 6 month old male was felt to be well at that time of immunization. Day before admission patient woke up with a moist cough but otherwise seemed well.  According to medical records he has: static encephalopothy, and a hearing loss bilatrally, he has a cochlear implant in his left ear, and a hearing aid in his right ear.  There are numerous other issues we are still dealing with related to his vaccine injury.  For more info, you may call me at phone # listed.  Information received from the annual follow up indicates patient has not recovered. According to patient's medical records he has: static encephalopathy, and a hearing loss bilaterally, he has a cochlear implant in his left ear, and a hearing aid in his right ear. There are numerous other issues we are still dealing with related to his vaccine injury. For more information you may call mother. Per 60 day follow up: He has permanent profound hearing loss bilaterally and static encephalopathy. His brain has been affected permanently in 3 ways: 1) atropahy around the whole brain, 2) sub-dural effussions in the back, and 3) the front left lobe was damaged.