Age: 27.0
Sex: F
Vaccine: MMR
Symptoms: Laboratory test abnormal, Lymphadenopathy, Nausea, Rash macular, Rash papular
Clinical narrative: Information has been received from a registered nurse concerning a 27 year old female with no known allergies, diabetes and depression who on 04/03/2002 was vaccinated with measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(lot # 640562/1374L).  Subcutaneously, in the right arm.  On 04/14/2002 the patient developed a "head to toe body rash with itching," "widespread rash" on her face and trunk which was characterized as "maculopapular".  Subsequently, the patient missed a few days of work.  A measles test was negative.  "She was rubella negative and rubeola positive."  Lab results on 04/15/2002 included: measles test negative, rubeola IgG 2.70, rubeola IgM 0.34, serum rubella immunoglobulin M antibody test 0.30.  Lab result for rubeola IgG before vaccine was 1.58.  On 04/19/2002, the rash improved and on 04/22/2002, the patient recovered from her "head to toe body rash with itching," "widespread rash" on her face and trunk which was characterized as "maculopapular".  Follow up information was received which included the medical record as follows:  03/20/2002 10:30 Lab Results: Rubella IgG: <5.0 IU/ml, Immune Status: Not IMMU, reference range: <5.0 IU/ml=not immune.  Rubeola IgG Ab 1.58 ISR, >=1.10 Positive, indicative of immune status.  04/03/2002: Consent for Rubella/Rubeola Vaccine: last menstrual cycle: 04/01/2002.  Patient received 0.5ml of MMR in right arm on 04/03/2002.  04/15/2002: First Report of Injury: Part of body injured: Whole body, Type of injury: Measles Received MMR vaccine.  T: 98.9.  MEDS: insulin, HA that comes and goes.  Joint pain is feeling better.  Nausea but no vomiting.  Blood sugars up and down.  120/80.  04/15/2002: Progress Note: Received call from patient stating she has broken out in "measles".  States it started on 04/14/2002, generalized rash on face and throughout body.  Has had low grade fever. M.D. is out, contacted infection control.  M.D. said IGM is fine, had no further suggestions for lab work.  Off work until we have results of lab work.  04/15/2002 @ 09:00:  Injury date 04/13/2002: First exam 04/15/2002 in employee health, days since injury (2).  mechanism of injury/illness-has rash that resembles Measles.  Received MMR 04/03/2002.  History and Physical exam: Presents with rash that resembles Measles.  Had MMR vaccine on 04/03, and started feeling ill on 04/13 with HA and nausea.  Rash started on 04/14 and is worse today.  Is IDDM and states sugars have been up and down.  Had joint pain early on, this is better.  Has been taking dephenhydramine (Benadryl) and IBU and acetaminophen (Tylenol).  PE: 120/80, pulse 80, T: 98.9.  Generalized rash noted on face, legs, trunk and back.  Appears like drug allergy rash, although states no new medications or soaps.  Does itch.  Lungs clear bilaterally.  Has some tonsillar lymphadenopathy.  Heart tones regular.  Plan: Treat symptoms, consulted with ID, IGM is all they suggested.  Off work until blood work is back.  Diagnosis: R/O measles virus, dermatitis reaction to vaccine.  Work restrictions/recommendations: Off work until IGM is back.  Next visit: 04/19/2002 09:00 Case status: Open.  04/15/2002: Consulted with M.D. He doubts it is the measles.  No need to contact other employees she possibly exposed.  04/15/2002: Lab Results: Rubeola IgM (0.34) Reference Interval Measles (Rubeola) Antibody, IgM: less that 0.90 UA (Arbitrary Unit)...Negative: No significant level of IgM antibody to measles (Rubeola) virus detected; Rubella IgM (0.30) Reference Interval Rubella Ab, IgM Less than 0.90 IV (Index Value)...Negative-No signoficant level of detectable Rubella IgM antibody: Rubeola IgG (2.70) Reference Interval Rubeola Antibody, IgG: greater than 1.09 IV...Positive: IgG antibody to measles (rubeola) detected which may indicate a current or previous exposure/immunization to measles (rubeola).  Positive IgG antibody levels in the absence of current clinical symptoms may indicate immunity.  04/19/2002 09:00: Days since injury (6).  Returns.  rash is better.   Still having slight HA.  IGM came back negative.  OK to work on Monday.  Follow up on Monday.  Diagnosis: R/O measles virus dermatitis reaction to vaccine.  Work restrictions/recommendations: off work.  Case status: open.  Next visit: 04/22/2002 14:30.  04/22/2002 14:30: Days since injury (9).  History and Physical Exam: Returns for follow-up.  Is doing much better.  Rash completely resolved.  Plan: release.  Diagnosis: R/O measles virus dermatitis reaction to vaccine.  Work restrictions/recommendations: released.  Case status: Closed.  Date closed 04/22/2002.  No additional information is expected.