Age: 1.05
Sex: M
Vaccine: DTAPHEPBIP, MMR, VARCEL, DTAPHEPBIP, MMR, VARCEL
Symptoms: Pneumonitis
Clinical narrative: Information has been received from a physician via the VZV identification program concerning a 13 month old male with DiGeorge's syndrome status post central shunt (March 2003) and Rastelli repair for tetralogy of Fallot (26-Jan-2004) who on 31-Mar-2004 was vaccinated with a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot number 646705/0823N) and a first dose of varicella virus vaccine live (lot number 637710/1248N) in the left leg. The patient was concomitantly vaccinated on 31-Mar-2004 with a dose of diphtheria toxoid (+) hepatitis B virus vaccine rHBsAg (yeast) (+) pertussis acellular 3-component vaccine (+) poliovirus vaccine inactivated (+) tetanus toxoid) (lot 21924A2) in the right leg. It was reported that the patient did not developed a rash at the injection site post vaccination. On approximately 26-Apr-2004, the patient developed diffuse bilateral pneumonitis possibly due to heart failure. The patient was afebrile. On 03-May-2004, the patient was admitted to the hospital with severe amenia, congestive heart failure, and bloody emesis. Patient had decreased po intake lethargy, and retching for 1 week prior to admission. On 13-May-2004, the patient's pneumonitis worsened. The patient developed an increased requirement for pressor support, worsening respiratory distress requiring intubation and had diffuse pulmonary opacities on CXR. Therapy with caspofungin was stated on 13-May-2004. On 20-May-2004, therapy with ribavirin, vancomycin, and piperacillin was started. On 21-May-2004, the patient developed a papular rash with 5 lesions scattered on the trunk. On 21-May-2004, therapy with acyclovir was started. A culture/PCR from tracheal aspirate for varicella and measles was performed on 19-May-2004 and 21-May-2004, and a papule specimen was taken 21-May-2004. Preliminary reports from the CDC revealed that the culture from tracheal aspirate taken 21-May-2004 and 2 urines were PCR positive for measles virus (Strain ID to follow). The PCRs were being repeated to verify the result. The physician reported that the patient had originally been seen by an infectious disease physician and placed on sufamethoxazole/trimethropim (Bactim) for a low CD4 count (320). The infectious disease (ID) physician advised that the patient should not be vaccinated with any live vaccines. It was reported that the patient did not have any recent exposure to shingles and exposure to chicken pox was unknown. Vaccination history included on 11-Jun-2003, the patient was vaccinated with a dose of diptheria toxoid (+) hepatitis B virus vaccine rHBsAg (yeast) (+) pertussis acellular 3-component vaccine (+) poliovirus vaccine inactivated (+) tetanus toxoid) (lot 21882C2) in the right leg, Hib conj vaccine (OMPC) (PedvaxHIB) (lot 1307L) in the left leg, and pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (CRM197) (lot 491589) in the left leg. Additional information has been requested. Follow up on 06/08/04 states: "Follow up information indicated that the vesicle and bronchial washings samples obtained on 05/17/04 were VZV positive and the VZV strain that was identified was vaccine-type. Follow up information was received from the physician who reported that the child's pulmonary disease was not secondary to the vaccinations he received. The physician indicated that he could not share additional findings at this time. Follow up information indicated that the patient died. PCR testing from autopsy samples on the lungs and lymph node were negative or VZV. Additional information has been requested."