Age: 1.4
Sex: M
Vaccine: PNC, PNC
Symptoms: Henoch-Schonlein purpura, Oedema peripheral, Rash
Clinical narrative: Information regarding Prevnar was received from a healthcare professional regarding a 17 month old male pt who experienced a rash on his feet that spread to his legs, feet and legs began to swell, swelling increased to the point that the skin cracked, swelling increased and went up to his torso and trouble breathing. At 17 months of age, the pt received the fourth dose on 11/14/03. On 11/14/03, about five hours post-immunization, the child developed a rash on his feet that spread to his legs (rash), then his feet and legs began to swell (oedema peripheral). The swelling increased to the point that the skin cracked (skin injury). He was seen in an ER, treated and released. On 11/15/03, the child was admitted to a hospital because the swelling increased and went up to his torso. As of 11/17/03, he was in an ICU with a rash and swelling of his legs and torso and trouble breathing. No additional info was available at the date of this report. Follow up info received from the initial reporting nurse provided a hospital summary. Within 24 hrs of vaccination, the child developed a rash on his feet that spread to his legs, and then his feet and legs began to swell. The swelling increased to the point that the skin crracked. He was seen in an urgen care facility, where it was noted that the rash involved both lower extremities, genitalia, lower abdomen and lower back. The impression of the urgent care heathcarre professional was that the child was having a reaction to the vaccination, and treatment with ibuprofen and Benadryl was suggested. The child did not improve with the ibuprofen and Benadryl. The rash started to progress further up the child's body and he also developed a fever, therefore, he was brought to an emergency room. The impression in the ER was that the child had a vasculitis that was progressively worsening. On 11/16/03, he was admitted to the hospital for more aggressive treatment. On examination, the admitting physician noted swelling of the knee and ankle joints as well as a petchial rash involving the entire lower extremities and extending up into the lower back and abdomen. His temp was 97.6 deg F. Review of all other body systems was normal. The impression was vasculitis and he was treated with Tylenol and prednisone. On 11/19/03, the pt was seen by a consulting physician. On examination, the child's temp was 97.1 deg F. The physician noted a generalized, palpable, purpuric rash extending from the pt's feet all the way to his groin. There was some evidence of bruising, especially on his feet. There were a few purpuric lesions on his scrotum, buttocks, and lower abdomen. The hands were also involved. The physician stated that the purpuric rash was due to Henoch-Schlein purpura. There was no gastrointestinal involvement. Treatment included  Tylenol as needed. The physician noted that this would likely resolve; however, there was a possibility of reoccurrence over the next several months. The pt was to continue to be monitored for renal involvement wiht a repeat urinalysis in a week and BUN and creatinine levels in a couple of months. The pt was approved for discharge from the hospital on 11/19/03. The initial reporting nurse stated that the child had recovered.