Age: 1.92
Sex: F
Vaccine: HIBV, PNC, HIBV, PNC13
Symptoms: Injection site erythema, Injection site urticaria, Peripheral swelling, Skin test negative, Urticaria
Clinical narrative: This is a spontaneous report from a contactable consumer. This consumer reported for his/her granddaughter with follow-up received from a contactable nurse on behalf of the physician. A 2-year-old female patient of an unspecified ethnicity received a single dose of PREVNAR 13, and HIB vaccine, both via an unspecified route of administration in the right leg on an unknown date in Oct2014. The patient's medical history included possible egg allergy at the age of 1-year-old (patient had red bumps in the diaper area and redness/soreness around her mouth after eating scrambled eggs but patient's mother is not sure how long after ingesting eggs that the reaction started), granola bar allergy, red bumps in the past that was attributed to viral infections, and father had a drug allergy, all on unknown dates. The patient did not have any gastrointestinal, throat or chest symptoms, had no other complaints, and had not been to the emergency room for any of these episodes. The patient had no significant nasal symptoms, atopic dermatitis, chest symptoms of coughing or wheezes; the birth history was normal. There was no significant family history of atopic diseases. The patient lived in a 100-year-old home with baseboard heating, one indoor cat that goes into her bedroom, and a 6-year-old carpet in her bedroom. The patient had no exposure to indoor cigarette smoke, daycare or basement. Concomitant medications were not reported. The clinical course was as follows: The patient had not been given any eggs or egg products in the past one year after the last episode when she was 1-year-old. Allergic reaction occurred on an unspecified date in Oct2014. A 2-year-old patient ingested a vegetable fruit smoothie at 9:00 AM and ingested scrambled eggs at her friend's home around 10:00 AM. Approximately at 10:30 AM, the patient had a bite of the granola bar that contained peanut and tree nuts especially almonds. Patient had tolerated this granola bar multiple times in the past and has also tolerated almonds and almond butter multiple times in the past. Patient also tolerated scrambled eggs after her allergy skin testing without any reactions. Approximately 30 minutes after ingesting the granola bar, the patient had hives on the inside of her thighs and upper arms and also started with some coughing and this episode was treated with BENADRYL and patient was taken to the emergency room via ambulance. Patient did not have any vomiting, diarrhea, angioedema. Patient tolerated bananas, rice, oats, wheat after the reaction without any problems. Allergy skin testing 05Nov14 was negative for peanut and all tree nuts. The patient had received pneumococcal 13-valent conjugate vaccine and haemophilus influenza type B vaccine on a Tuesday (unspecified date in Oct2014) approximately two days before the reaction and had some red spots on her buttocks and right leg on Wednesday and Thursday on an unknown date in 2014. The patient continued to have red spots and urticaria around the injection site on her right leg for a couple of days after the reaction. On 05Nov2014 and 06Nov2014, the patient experienced mild hives on right leg and buttock. On 07Nov2014, she developed swollen hands, 30 minutes of coughing, hives on both legs, arms, and face. Allergy skin testing 12Aug2014 was negative to egg white and egg yolk. ImmunoCap testing on 29Aug2014 was negative to egg white, egg yolk, ova-albumin, and ovo-mucoid. Allergy skin testing 05Nov2014 was negative to egg white and egg yolk for the second time, and negative for peanut and all tree nuts. ImmunoCap testing on 14Nov2014 was negative to peanut, hazelnut, Brazil nut, almonds, pecans, cashew, walnut, macadamia nut. The patient had a blood test on an unknown date which was negative for peanut/tree nuts. Therapeutic measures were taken in response to the event of mild hives on right leg and buttock included treatment with BENADRYL on an unknown date in 2014. Therapeutic measures were taken in response to the event of some red spots on her buttocks and right leg included treatment with coconut oil and antifungal cream, which was given by the parent. The clinical outcome for the events of mild hives on right leg and buttock was recovered after treatment with diphenhydramine hydrochloride on an unknown date in 2014. The clinical outcome for the event of some red spots on her buttocks and right leg, which occurred off and on, resolved each time after treatment with the creams on an unknown date in 2014. The clinical outcome for the events of swollen hands, 30 minutes of coughing, and hives on both legs, arms and face was unknown. The reporting physician stated the reaction may have been possibly delayed from the vaccines which were given two days prior to the reaction, as the reporting physician stated that the patient was negative by stem test and blood test for peanut/tree nuts, and a delayed reaction may have been from possible since the patient was immunized two days prior to the reaction. Follow-up (12Dec2014): New information reported from a contactable nurse on behalf of the physician includes: reporter information, suspect product data (changed dates from 04Nov2014 to an unknown date in Oct2014, and added administration site), added relevant medical history, clinical course, relevant lab data, added event of had some red spots on her buttocks and right leg, added treatment (for the events of mild hives on right leg and buttock and had some red spots on her buttocks and right leg), outcome (changed from unknown to recovered for the event of mild hives on right leg and buttock), and causality (possible). Follow-up (28Jan2015): New information reported from a contactable physician includes: reporter information, updated relative lab data, and clinical course. Follow-up attempts completed. No further information expected.