Age: 8.0
Sex: F
Vaccine: VARCEL
Symptoms: Abdominal pain, Abdominal tenderness, Azotaemia, Blood test normal, Computerised tomogram abdomen normal
Clinical narrative: Information has been received from a physician concerning an 8 year old female patient with no pertinent medical history and no drug reactions/allergies who on 06-APR-2010 was vaccinated subcutaneously with the second 0.5 ml dose of VARIVAX (Merck) (lot # 666044/1428Y). There was no concomitant medication. On 07-APR-2010 the patient developed severe abdominal cramping, redness and tenderness of her arm at the injection site. The patient was admitted to a hospital. CT scan of abdomen was performed with result within normal limits. Multiple blood tests were performed indicating all within normal limits. At the time of the report, the patient had not recovered. Follow up information was received from the physician concerning the female patient who on 02-FEB-2006 was vaccinated with the first dose of VARIVAX (Merck) (lot # 651050/0333R). Concomitant vaccinations included IPOL and TRIHIBIT. On 16-APR-2010, the patient received the second dose of VARIVAX (Merck) (lot # 666044/1428Y) with no concomitant vaccinations. On the morning of 08-APR-2010, the patient was admitted to a hospital for a "short stay" and was discharged in the evening of 08-APR-2010. At the time of the report, the patient had recovered. The physician felt that the patient had a reaction to the second dose of VARIVAX (Merck). Follow up information has been received from the physician and medical records. On 06-APR-2010 the 8 year old (also reported as an almost 9 year old) female patient with no adverse events following prior vaccination, no illness at time of vaccination and no pre-existing allergies, birth defects, medical conditions saw her doctor for a regular well-child visit and was vaccinated with the second dose of VARIVAX (Merck) (lot # 666044/1428Y) in her left arm. The following day, on 07-APR-2010 the patient began having abdominal pain and extreme nausea, but no vomiting. The mother called on the morning of the 7th, and was counseled about drinking a light diet, and trying PEPTO-BISMOL. The patient was seen later on the same day because of an extreme nausea and episodically cramp abdominal pain (ala intussusception). When seen in the office, the parent allowed that the patient had normal bowl movements, but none on the date of observation. Physical examination at that visit revealed this patient balled up in a fetal position when she got the cramps, and then would gradually stretch out to a more normal supine position. Her vital signs the included a blood pressure of 104/56, and a pulse of 108. Examination was absolutely normal with normal bowel sounds, no guarding or rebound and only subjective tenderness along the left side. After leaving the office, the patient had continued episode of cramp abdominal pain, but finally went to sleep at about 4:00 although she was very fitful in her sleep. She would not take her PEPTO-BISMOL. Her mother called on the morning of admission with his above history, and the patient was in a great deal of pain. A urine had been obtained in the office on 07-APR-2010, and was absolutely normal with a specific gravity of 10.15, and no other chemical abnormalities noted. With a need for pain relief, the patient was admitted to the hospital, and an abdominal CT scan with contrast was ordered along with a CSC and a BMP, an amylase, and a lipase. Physical examination on the Pediatric floor of the hospital revealed a tearful, uncomfortable, cooperative, almost 9-year-old who was complaining of diffuse abdominal pain with no location. Examination of the abdomen revealed active bowel sounds. Palpation of the abdomen revealed nothing but subjective tenderness with no guarding or rebound. Of interesting note, the child's chickenpox injection site in the left deltoid region was diffusely red, and quite tender. Examination of the head, eyes, ears nose and throat revealed no abnormality. The lungs were clear, heart sounds were normal without murmur, genitalia were that of a normal prepubertal female and the extremities were clear with no purpuric rash. The patient was started on full maintenance IV fluids. The laboratory results were entirely normal except for evidence of azotemia which was secondary to the patient not being able to drink anything over the preceding 24 hours. The child received two doses of IV Morphine 0.05 mg per kilogram which did provide for adequate relief of the abdominal pain. The abdominal CT was unremarkable. The laboratory data including the CBC, amylase, lipase, and BMP were unremarkable except for the azotemia. The child was given full maintenance IV fluids with D10W, and over the course of the day, the child's symptoms completely resolved. The CT scan was unremarkable, and it was felt that the patient probably had an adverse reaction to the second chickenpox vaccine instead of the concern which was that the child was coming down with HS purpura, and had not developed the cutaneous lesions yet. Nevertheless, the patient was well by the evening. Her appetite had returned with a vengeance, and she was released to her mother to be followed up in the office in one week. She was released on no medication in satisfactory condition with a normal mental health status. Social history was of questionable significance in that the parents were divorced, and they were shared custody, and father had a new girlfriend. Additionally, there is no known exposure of similar illness. Additional information is not expected. All Medical records will be made available upon request.