Age: 0.17
Sex: F
Vaccine: DTAPIPVHIB, HEP, PNC13, RV5
Symptoms: Bordetella test positive, Choking, Cough, Crying, Cyanosis
Clinical narrative: Thursday, 02/14/13, adverse events began with severe coughing, vomiting, and gagging. Contacted pediatrician's office (mother of patient), was instructed to leave a message. Later that day the call was returned by a nurse in the office. I was instructed to use nasal saline for irrigation to loosen mucus, introduce humidifier into the environment, and elevate child's head during sleep. Advised that child is too young for any medication. At home I began immediately using saline in nostrils, humidifier/vaporizer, and elevated her on a pillow. Friday, 02/15/13 At home: made necessary changes to elevate babies head, used humidifier during the night, and began using nasal saline and aspirator to nose and throat. No change in babies coughing, choking, vomiting, and gagging. Coughing is increasingly worse with no change in severity or frequency. Saturday, 02/16/13. Contacted dr after hours by phone with MD on-call. Instructed to take baby to After Hours Pediatrics a doctor will be available after 1:00 PM. On-call doctor advises to take baby to ER if in distress. Reported severe coughing with choking, vomiting, and gagging since Thursday, 02/14/13, to dr. After checking lungs, throat, nose, and ears dr reports baby's lungs sound clear but may have bronchial problems. He instructs patient to continue nasal saline, elevate head, and use humidifier. Limit use of nasal and throat aspirations as this may increase irritation. Doctor commented that baby is too young for any medications. Symptoms at home include: severe coughing with choking, vomiting, and gagging persists. Sunday, 02/17/13. Coughing is persistent and becomes even more severe. Rushed baby to ER at the Medical Center around 0700 AM. Patient seen by PA, he ordered breathing treatment with Albuterol and a dose of Prednisone. Next, he advised patient to continue previous at home instructions and follow-up with pediatrician in two to three days. After the emergency room visit baby's coughing subsided slightly then restarted violent coughing throughout the night. Monday, 02/18/13. Contacted dr's office made 3:00 PM appointment to see PA. Explained symptoms of severe coughing, gagging, and vomiting to PA and made aware of doctor visit and ER visit. She advised to continue saline with aspiration before feedings, elevate head, and continue using humidifier. PA introduced PEDIALYTE to give between feedings and gave a nebulizer to use at home. At home: symptoms persist with no change after using nebulizer every four to six hours as needed. Tuesday, 02/19/13. Office visit with dr, he was able to hear patient cough briefly and suspected Pertussis (Whooping Cough). He immediately prescribes azithromycin 100mg/5ml and lab work to confirm diagnosis. He advises to continue previous at-home instructions and report back to the office Wednesday morning. First dose of antibiotic administered at 7:00pm Tuesday night. No change in coughing spells. Wednesday, 02/20/13. Office visit with dr, gives information about symptoms then advised parents get DTaP booster. MD will call when diagnosis is confirmed and will prescribe an additional five days of antibiotics. At home she continues to cough violently. Thursday, 02/21/13. At home coughing wakes baby from sleep her cough is still persist with a slight decrease in frequency in the total number of cough throughout the day. Patient continues choking with a different sound and gagging more with reduced audible coughing. Stops breathing with prolonged coughing when awaken from sleep. Friday, 02/22/13. Pediatrician's office calls with results that confirm Pertussis as the official diagnosis and prescribes an additional five days of antibiotics for patient. The health department wants other siblings treated for Pertussis and Z-Packs are called to the local pharmacy. Paramedics are called to the home after dialing 911. Baby turns blue and purple then stops breathing from gagging and choking, she is unable to cough. She begins breathing again before the paramedics arrive after I tool her on the porch for cool air and bounce her on my shoulder. She has trouble breathing for approximately 10 to 30 seconds. Then, she is able to recover with coughing and crying. Paramedics advise to call them again or take her to the nearest ER if I want her to be monitored or if she passes out from coughing. Saturday, 02/23/13. Baby's  coughing is severe yet less frequent throughout the day. She has several long (2mins to 3mins) bouts of coughing with one to two seconds of non-breathing.