Age: 76.0
Sex: F
Vaccine: FLU3
Symptoms: Abdominal pain, Blood culture, Blood gases, Breath sounds abnormal, Bronchiectasis
Clinical narrative: Initial report received from the pt's daughter on 12Oct05. A 76-year-old female pt, with medical history of sarcoidosis, diabetes type II, hypothyroidism, C-DIF, high blood pressure and high cholesterol, had received a left deltoid injection of Fluzone (lot unk) on 06Oct05 around noon. By the evening of 07Oct05, the pt's arm was sore and she developed a lump at the injection site. During the evening, the pt's oxygen levels had decreased from 91/94 to 84-89. On 08Oct, she developed a slight temp of 99.8F, her oxygen levels were decreased from normal to 88-90, oxygen saturation levels were 55-60 ans she had increased cough. Pt was normally on 2.5 liters of oxygen, oxygen was increased to 4 liters over the next three days gradually. On 09Oct, pt's oxygen levels were 80-85. When the pt's daughter listened to her lungs, she heard gurgling. Pt's temp was 99.8F. Pt's normal dose of Lasix was increased from 40 to 60mg and Prednisone was increased from 12.5 to 20mg. Pt had slight improvement over the next day with oxygen levels at 90-93 and no gurgling present in lungs. On 10Oct, normal doses of Lasix and Prednisone were administered. Pt's temp was 98.8F. During the evening of 11Oct, pt had a temperature of 99.8F and her oxygen levels decreased to 88-90. 12Oct morning, she became winded trying to get out of bed, developed trouble breathing, gasping for air, her lips turned blue, her face was red, she had the chills, began shaking and coughing. Her oxygen levels were 55-60. Prevacid was given. A breathing treatment was given with no success of oxygen levels improving. Pt was admitted. For the symptoms, the pt received Benzonatate, Tylenol, Metronidazole and Macinex, pot chloride. Per the pt's daughter, the physician stated he felt the Fluzone vaccination caused the onset of the pt's symptoms because her immune level is low. She received concomitantly for medical conditions Caduet, Metoprolol, Lotrel, Amaryl, Levothyroxin and aspirin. Pt's recovery status: not reported. Follow-up received on 01-Nov-2005. As per the additional information, the patient had a past medical history of mediastinal lymphadenopathy, respiratory failure and depression. She has also past surgical history of hysterectomy, status post tracheostomy and cataract surgery. The lot number of the influenza vaccine administered is U1810AA. The patient hospitalised from 12-Oct-2005 to 23-Oct-2005 and she was readmitted again on 26-Oct-2005. Later, on 28-Oct-2005, she was transferred to another hospital for cardiac catherisation. The patient presented at medical center with the chief complaint of shortness of breath and acute exacerbation of an unspecified time. She was hypoxemic in the same morning at home. Oxygen saturation was in the range of 60 to 65. She has a history of sarcoidosis, congestive heart failure. She also had fever, chills or palpitations. She is also complaining of abdominal pain. She was evaluated in the emergency room, her Oxygen saturation on 100% non- rebreather mask was 92%. Her abdomen showed generalized tenderness. She was complaining of shortness of breath. Review of systems was significant for chief complaint of shortness of breath and abdominal pain. The patient denied other symptoms such as seizures, syncope, dizziness, blurry vision, chest pain, hemoptysis, nausea, vomiting, constipation, diarrhea, arthralgias, frequency, incontinence, fevers, chills or weight loss. Physical examination Showed the patient alert and oriented, in mild respiratory distress. She is sating 92% on 100% non-rebreather, pulse 118, respirations 32 per minute. Head and neck examination showed normocephalic, pupils are equal and react to light. Neck was supple. No Jugular venous distension, masses, goiter or carotid bruit. Heart: S1, S2, regular, no gallop or murmur. Lungs: Decreased breath sounds bilaterally with bilateral basilar rales. Abdomen: Soft, generalized tenderness, no evidence of any organomegaly. Extremities: no cyanosis, clubbing, edema. Central nervous system examination Showed no evidence of any focal neurological deficit. Chest x-ray showed evidence of bilateral lower lobe densities up to the lower halves of both the right and left hemithorax, which could be secondary to sarcoidosis, however overlying pneumonia can not be excluded. Review of the CBC of 12, hemoglobin of 13, hematocrit of 21, platelet count of 305, troponin was 0.05. According to the reporter, the impression was hypoxemia with respiratory failure, sarcoidosis, pneumonia, diabetes, hypertension but ruled out pulmonary edema, asthma and abdominal pain. She was also taking bentonite, ADVAIR, ATROVENT, calcium, vitamin D, prednisone 12.5 mg, LEXAPRO, metoprolol, LASIX and potassium. Outcome was not reported because the reporter was not sure whether the patient was recovered.