Age: 0.56
Sex: F
Vaccine: DTAPHEPBIP, DTAPHEPBIP
Symptoms: Contusion, Cyanosis, Decreased appetite, Erythema, Peripheral vascular disorder
Clinical narrative: This case was reported by a nurse and described the occurrence of an allergic reaction in a 6 month old female pt who received diphtheria and tetanus toxoids and acellular pertussis adsorbed, hep B recombinant and inactivated poliovirus vaccine combined (Pediarix). The nurse reported this case directly. The pt's medical history included shoulder dystocia with a brachial plexus injury at birth. The pt has no known drug allergies. At the time of the third administration of Pediarix, on 29Dec04, the pt had diaper rash. On 19Oct04, the pt received the second dose of Pediarix in the left thigh (lot 21928A2). The mother reported to the nurse that following the second dose of Pediarix, on an unspecified date in Oct 2004, the pt developed a mild rash on her body that resolved in one day. The nurse reported that this rash required no treatment. On 29Dec04 the pt received the third dose of Pediarix in the left thigh at 10:15AM (lot AC21A004AA). At about 6:00PM on 29Dec04, the pt experienced a facial rash described as red blotches on the face. The following day, on 30Dec04, the pt experienced a facial rash over her entire body. The nurse described the rash as a thick blotchy red area similar to a sunburn located on her trunk. The nurse also stated that the rash was not warm to touch. On 04Jan04 the pt developed fever of 99.7 F and was seen in the ER. The pt was diagnosed with an ear infection, dermatitis after immunizations, and the diaper rash that had appeared prior to the immunizations was diagnosed as monilial diaper rash. The pt was prescribed Benadryl, Amoxil and Nystatin cream. The ER physicians stated that the rash is likely an allergic type reaction possibly to the recent immunizations. On 05Jan05, the pt experienced worsening of her rash and was seen in an ER. Lab investigations were notable for decreased neutrophils at 20.1 percent and elevated monocytes at 16.9 percent. Metabolic profile, urinalysis, and all other hematological analysis were normal. The physician agreed with the previous diagnoses of an allergic reaction, otitis media and monilial diaper rash. the pt continued her therapy with Benadryl, Amoxil, Nystatin cream. The pt was prescribed baby oil bath rubdown. On 06Jan05, the pt was seen in the physician's office. Therapy with Amoxil was discontinued. Approx nine days following the third administration of Pediarix, on 07Jan05 the pt developed a fever of 100.1 F, a worsening of the rash, bruising of her arms, decreased appetite, respiratory problems, and a bluish coloring on hands and was again seen in the ER. A throat culture was negative for beta hemolytic Streptococci and positive of yeast, probably Candida albicans. The pt was treated with Benadryl and Prelone. The nurse stated that the pt underwent blood tests which were negative. The pt was diagnosed with an allergic reaction to the DTPa component of Pediarix. The allergic reaction was considered to require clinically serious intervention. The ear infection resolved on 07Jan05 and the allergic reaction resolved on 21Jan05.