Sex: M
Vaccine: PNC, PNC, PNC, PNC, PNC
Symptoms: Otitis media
Clinical narrative: This case was considered medically important.  Additional information was received that provided event details including dates of events, allergy consult report results, additional vaccine administered, additional laboratory results and recovery status.  Information regarding PREVNAR was received from a healthcare professional regarding a male patient who completed his four dose primary series of PREVNAR on 29-Oct-2003.  In Apr-2006, the patient experienced a re-occurring otitis media.  The reporter noted that patient's titer levels showed no response to some serotypes and minimal response to the remaining serotypes in PREVNAR.  The patient has a past history of otitis media (occurrences in Nov-04, Apr-05, Jan-06, Feb-06, Apr-06.  The patient recovered from all otitis events).  (See related cases below).  Product was administered on 29-Oct-2003.  Additional vaccines administered on 01-May-2007 included DTaP, IPV, MMR II, VARIVAX and PNEUMOVAX 23.  On-23-Oct-2003, the patient completed his four dose primary series of PREVNAR.  In Apr-2006, the patient experienced a re-occurring otitis media.  The reporting physician noted that patient had 4 previous otitis media episodes from which he recovered.  On an unspecified date, the patient was referred for an ears-nose-throat (ENT) consult (results not reported).  On 19-Apr-2007, the patient was evaluated by an allergist who performed pneumococcal titer levels.  The allergist noted that the patient's titer levels showed no response to some serotypes and minimal response to the remaining serotypes included in PREVNAR.  (See pneumococcal serotype antibody results below).  The allergist additionally noted that PREVNAR may have been ineffective for the patient and indicated the patient may have some allergies as well.  The reporting physician opted to give the patient a dose of PNEUMOVAX 23 administered on 01-May-2007 along with other childhood vaccines.  The patient recovered from the otitis media event on an unspecified date.  On 10-Jul-2007, the patient had repeat pneumococcal titer levels drawn (See laboratory section for results).  All titer levels were noted to be in the "protective level" range.  The reporter noted that the child had a good response to PNEUMOVAX 23.  As of 10-Jul-2007, the child had recovered from the events.  On 10-Apr-2007 test results were: antibody test (results: serotype 6B - >20, serotype 19F - 2.3, serotype 23F - 1.1, serotype 1BC - 0.5, serotype B - 0.3.  All other serotypes were <0.2 -These serotypes include: Serotype 1, 3, 4, 7F, 9N, 9V, 12F, 14 (reference range >1.0 ug/ml ... Protective level)); blood immunoglobulin G (results: 622 mg/dl); complement factor (results: 41 IU/ml); platelet count (results: 403 x10^3/mm^3); blood immunoglobulin A (results: 93 mg/dL); and blood immunoglobulin M (results: 64 mg/dL).  Antibody test (results: Serotype 4 - >16.6, serotype 6B - >20.0, serotype 9V - >20.0, serotype 14 - >20.0, serotype 18C - >14.7, serotype 19F - >20.0, serotype 23F - >20.0 (reference range  - >1.0 .... Protective level)) was done on 10-Jul-2007.  See related case(s): HQWYE105409MAY07 (adverse event, non-expedited); HQWYE105509MAY07 (adverse event, expedited); HQWYE105609MAY07 (adverse event, expedited); HQWYE105709MAY07 (adverse event, expedited); and HQWYE105809MAY07 (adverse event, expedited).  No additional information was available at the time of this report.