Age: 49.0
Sex: F
Vaccine: FLUX, PPV
Symptoms: Cellulitis, Haematocrit decreased, Haemoglobin decreased, Injection site cellulitis, Injection site erythema
Clinical narrative: Information has been received from a registered nurse concerning a 49 year old female patient with cancer and no drug reactions or allergies who on 03-NOV-2008 was vaccinated with a 0.5ml dose of PNEUMOVAX (lot # 661529/0868X). On 03-NOV-2008 the patient experienced cellulitis in the arm of administration. No lab diagnostics studies were performed. The patient was recovering from the cellulitis in the arm of administration. The patient sought medical attention via seen at the practice. Follow up information has been received concerning a 49 year old female patient with cancer, asthma, thrombocytopenia and macrocytosis who on 03-NOV-2008 was vaccinated with a 0.5ml dose of PNEUMOVAX (lot # 661529/0868X). Concomitant medication included influenza virus vaccine (unspecified) and darbepoetin. The illness at time of vaccination was multifactorial anemia thought to be related to her ulcerative colitis. On 03-NOV-2008 the patient developed the right upper biceps tenderness, erythema and swelling. She reported on right hand numbness nor tingling, but the tenderness was on the medial and axillary portion of her right upper arm. The patient denied shortness of breath, chest pain. She had no fevers, chills, night sweats, cough, cold, congestion or shortness of breath. Physical examination was performed, and the result showed that there was multilevel sites of mechanical purpura, the upper extremity had evidence of erythema running circumferential around the right biceps, and there was tenderness appreciated in the medical aspect deep portion of the right axilla in addition to the lateral aspect of the shoulder. The physician assessed that recent PNEUMOVAX and flu injection resulted in right upper extremity tenderness and swelling, and he could not rule out deep vein thrombosis (DVT) based on the patient's physical exam. A Doppler will be ordered in addition will start AUGMENTIN. The physician also recommended the patient took BENADRYL, but the patient stated that caused profound anxiety. He would have the patient start antihistamine in the form of ZYRTEC 10 mg daily. On 06-NOV-2008, the patient was seen in triage for redness and soreness in right upper arm. The deltoid muscle was still sore. The patient stated that there was some redness in the deltoid on 05-NOV-2008 and there was horizontal reddening across the inner bicep on 06-NOV-2008. The patient had tenderness in bicep, deltoid, and under armpit. DEG was asked to evaluate patient. On 12-NOV-2008, the patient stated that she was "doing very well". There was no swelling or soreness in her right arm or bicep. The redness was gone also. The patient had one more day of antibiotic to finish. On 14-NOV-2008, the patient came to triage following a lab draw. Labs reviewed with HGB 11.1, HCT 33.3. Blood pressure slightly elevated at 144/91 and patient stated that she had been up since 4:30 in the morning. Patient's right arm had no more redness or swelling. The patient stated that "it was feeling much better". Cellulitis in the arm of administration was considered to be disabling and an other important medical event. This is one of several reports from the same source. Additional information is not expected.