Age: 1.22
Sex: M
Vaccine: DTAP, FLUX, HIBV, MMRV, PNC13, DTAP, FLUX, HIBV, MMRV, PNC13
Symptoms: Bacterial test negative, Crying, Incisional drainage, Induration, Injection site abscess
Clinical narrative: This spontaneous report as received from a nurse refers to a 14 months old male patient with no pertinent medical history, drug reactions or allergies. On an unknown date the patient was vaccinated with three respective dose of PROQUAD (merck) (lot #, expiration date and dose unspecified) injection, PEDVAXHIB (lot #, expiration date and dose unspecified) injection and PREVNAR 13 (lot #, expiration date and dose unspecified), they were all administered intramuscularly, and they were all administered right next to each other on the patient's right thigh. No concomitant medication included. The patient's parents brought him to see the physician as the area with the three injection sites swelled up "to the size of a golf ball". The swollen area was lanced by the physician and was filled with serous fluid. The fluid was sent for a culture, but was determined to be negative with no bacterial growth. The patient sought medical attention by visiting the office. The event outcome was reported as recovering/resolving. Follow up information has been received on 08-APR-2014 from physician. The case referred to 14 months old male patient with no known allergies, no previous hospitalizations, no prior surgery or no significant history. The patient had reactive airway disease vs asthma (has used Albuterol nebs in past). The patient lived with parents who had: Mom - Asthma, Hepatitis C+ lab in May 2012 and Dad: Asthma. The patient was secondhand cigarette smoke exposure. He was induced at 37 weeks due to mom's Hep C dx: delivered via C-section for failure to progress. He had reactive airway disease vs asthma Q1 as used Albuterol nebs in past) - Asthma, unspecified - Probable Dx. The patient developed a sterile abscess was due to which underwent incision and drainage (I and D) on Unspecified Site on Right thigh on 25-FEB-2014 and did fine after that. The patient was vaccinated with third dose of PEDVAXHIB (lot # J005668, expiration date: 05-DEC-2015, vaccinated intramuscularly in right thigh; dose unspecified) injection; first dose of PROQUAD (merck) (lot # J004175, expiration date: 08-OCT-2014 vaccinated intramuscularly in right thigh; dose unspecified) injection; the fourth dose of PREVNAR 13 (lot# G45476), the fourth dose of INFANRIX (lot # AC148149BL) in left thigh and the second dose of influenza virus vaccine (manufacturer unknown) (lot #, expiration date and dose unspecified) in left thigh. Check leg where he received shots yesterday. Left leg pain likely related to his immunizations yesterday. The pertussis would be the most likely culprit for this. The doctor didn't see any signs of a serious reaction there. Right leg pain and enlarging lesion appears to be most consistent with a Staph infection this is adjacent to but really not immediately involving the area of the injections. There's nothing to culture here. The doctor didn't want to numb it up and cut down on it as the doctor think the chance of actually having pus in there at this point is small. Because of that, the doctor will go ahead and put him on BACTRIM which should cover MRSA. The doctor was not scheduling any definite F/U. The patient was treated with sulfamethoxazole (+) trimethoprim 200-40 mg/5ml suspension, 30 days, 0 refills, 5.5 ml bid x 10 days; albuterol Sulfate (2.5 MG/3ML) 0.083% NEBU, 30 days, 1 refills, 1 vial via nebulizer every 4 hours (q4h) as needed (prn) cough/short of breath; azithromycin 100 MG/5ML SUSR, 30 days, 0 refills, 6 ml today, then 3 ml daily x 4 days; Nebulizer/Tubing/Mouthpiece KIT, take as directed, 180 days, 1 refills, Ox; 493.90. The patient presented on 21-FEB-2014 with his mother for evaluation of bilateral leg pain and swelling on the right. The patient received 5 or perhaps 6 immunizations in the thighs yesterday at Public Health. All day on 21-FEB-2014 he's been unwilling to bear weight on the left leg but he's developed a red bump on the right leg that has doubled in size since this morning. He has been crying quite a bit. Mom thinks he's had a low-grade fever. They've been giving him TYLENOL and ibuprofen. On 21-FEB-2014 at 03:19pm the patient had temperature axillary 98 F and weight 24 lbs 12.8 oz. The patient was alert. He's in no distress. He had been crying and then wasn't crying although he did cry when I touched his right leg, or if we tried to get him to stand, he would not bear weight on the left leg. Exam of the right thigh showed 3 small areas where he had the needle pokes yesterday that have a tiny scab on them, but it's about 1 to 2 cm lateral to that is a 16 x 20-mm red, erythematous, indurated area not fluctuant and it is tender to touch. Exam of the left thigh does show 2 tiny scabbed areas where he's had needle pokes yesterday. The entire area may be somewhat tender to touch although it's difficult to judge. He does move the leg spontaneously. There's no definite rash anywhere there. No swelling necessarily on either side except for the lesion noted above. Mom does think that the one of the legs is swollen but I can't say that is certain. Hours later on Saturday evening and he's been walking fine since but the bump and lump on his right thigh really hasn't changed significantly. He's not having any fevers. It does seem to be sensitive to touch. He remains on the trimethoprim sulfa. Medical: Environmental Exposure: Secondhand cigarette smoke exposure. -Induced at 37 weeks due to mom's Hep C dx; delivered via C-section for failure to progress. On 25-FEB-2014: Temp-Axillary 97.2 F. The patient was walking around the room. He's in no distress. Afebrile. Exam of the left thigh showed it appears normal. No evidence of any swelling. Exam of the right thigh showed that he continued to have an approximately 2 cm diameter of erythema. It was indurated. It did feel a little bit fluctuant at this point. It was tender to touch. He did withdraw and cry when the doctor touched it. Component SPECIMEN (collected on 25-FEB-2014) DESCRIPTION RIGHT THIGH. On 02-MAR-2014, the patient was on antibiotics. He was found to have gram stain: Few WBC's seen, rare epithelial cells seen, no organisms seen. Culture. Due to Probable contaminant, (doubtful cause of abscess) were found Streptococcus mitis group and from broth only viridans streptococci were sensitive to Penicillin and Ceftriaxone, with or without aminoglycoside's. The patient recovered from the events on 27-FEB-2014. Guessing it was PROQUAD (merck) causing reaction only because it was his 1st and no reactions from other shots. All available medical records will be provided upon request. Additional information has been requested.