Age: 0.3
Sex: M
Vaccine: DTAP, HEPA, MMR, VARCEL
Symptoms: Decreased appetite, Inappropriate schedule of drug administration, Mumps, Pallor, Rash maculo-papular
Clinical narrative: Information has been received from a healthcare worker concerning a 4 month old male who on 19-NOV-2008 was vaccinated with a dose of VARIVAX (Merck) and MMRII.  The patient has not experienced any known symptoms.  It was unknown if the patient sought medical attention.  Follow-up information was received on 11-DEC-2008 from a certified assistant C.M.A. indicating that the patient developed mumps following the administration of MMRII and VARIVAX (Merck) on 19-NOV-2008.  The patient also received DTaP and HAVRIX on 19-NOV-2008.  At the time of the report, 11-DEC-2008, the patient had not recovered from the mumps.  The patient was returning to the office on 15-DEC-2008 for follow-up.  Follow-up information was received on 05-FEB-2009 from the C.M.A. and the physician via medical records indicating that on 19-NOV-2008, at 16:25, the patient with a history of bronchitis (onset 31-OCT-2008) was vaccinated with a first dose of VARIVAX (Merck) (Lot #661664/1187X) in the right leg and a first dose of MMRII (Lot #656526/0284U) in the left leg.  It was reported that the patient was followed "the next day and then in a week" and there was no medical problem.  On 03-DEC-2008, in the morning, the patient developed a rash suddenly found by the mother.  The child was taken to a clinic and at this point, the mother reported that the child had had only the rash, but no fever, a little bit of decreased appetite, but taking orally.  His reflex seemed to be a little bit more present, but there was no vomiting.  According to the mother there was normal neurologic activity.  The child was playful, making good eye contacts, smiling and there were no other constitutional symptoms.  He was again taking his oral formula and he was just without any problems  having his normal bowel movements.  It was reported that the child had not had any contact with any other sick child.  Physical examination showed a macular papular rash over the patient's abdominal area more prominent in the trunk and the upper chest and upper back, some of these are tracking up to the skull in the back very little on the face and some of this was on the upper extremities all the way to the distal portion of the lower extremities to the distal portion.  It was blanching, it was not vesicular and there were no other abnormalities on the skin.  The physician's assessment was viral exanthem.  The physician highly suspected that it was related to MMRII and VARIVAX immunization that the child received.  The physician planned to obtain IgG and IgM titers and gave the patient's mother instructions of signs or symptoms to look for that may indicate a more serious/severe problem.  Laboratory testing was performed (Varicella Zoster Abs, IgG/IgM) on 03-DEC-2008 and results on 10-DEC-2008 indicated Varicella Zoster IgG = 2.14 which was indicative of a positive test.  The test results for the same test on 05-DEC-2008 had been negative <0.90.  At the time of the report, the patient had recovered.  Additional information is not expected.