Age: 11.0
Sex: M
Vaccine: VARZOS, MNQ, TDAP, VARZOS
Symptoms: Injection site warmth, Peak expiratory flow rate, Skin lesion, Wrong drug administered
Clinical narrative: Information has been received from a healthcare worker referring to an 11 year old male patient. On 24-AUG-2015 the patient was inadvertently vaccinated with ZOSTAVAX (dose, route, lot # and expiration date were not provided) instead of VARIVAX (Merck). No adverse effects were reported. Follow-up has been received from a physician and the physician's assistant via medical records on 14-OCT-2015, concerning 11 year old male patient. The patient's concurrent conditions included allergic rhinitis, asthma exercise-induced, attention-deficit hyperactivity disorder, hypoglycemia and allergy to penicillins (captured in MARRS#1510USA008648). The patient did not smoke, did not use alcohol, drugs and marijuana. The patient was on no high-fat diet, a high-salt diet not from processed foods and a high-sugar diet not including sweet snacks. His diet was sufficient food variety, sufficient in fruit and vegetables. There was no decrease in fluid intake. Daily cola consumption was also reported. The patient exercising regularly. The patient's medical history included surgical hernia repair in approximately 2008 (reported as at age 4). On 24-AUG-2015 at 11:53 am, the patient was vaccinated with the first dose of ZOSTAVAX (lot# L021608) in the left arm. On the same date the patient was vaccinated with a dose of ADACEL (lot# U5241AA) in left arm intramuscularly and with the first dose of MENACTRA (lot# U51866A) in right arm. Concomitant therapies included VYVANSE, PROAIR HFA and TYLENOL. He did not take any other OTC medications or vitamin supplements. On 25-AUG-2015 the patient's left arm was red, warm and swollen. The patient did not have fever or pain, just slight discomfort. On the same day, he was seen by the physician. He was well developed, well nourished, in no acute distress. Lung examination showed normal breath sound/voice sounds, no wheezing was heard, no rhonchi were heard, no rales/crackles were heard. Cardiovascular examination showed that heart rate and rhythm was normal, no murmurs were heard. Skin examination showed lesions warm erythematous lesion, in 7.5 x 3.5 cm which was slightly raised secondary to immunization over the distal deltoid muscle on the left upper arm, there was no lymphedema or lymphadenoma in the axilla. Cellulitis of the upper extremities was diagnosed. Pulse oximetry on 25-AUG-2015 was 98 (units not provided). Peak flow assessment was performed with a result of 300 L/min. The physician's assessment included cellulitis on left arm (deltoid). The patient received education and instructions. He was advised to use sunscreens/ sunblocks SPF 40 (reapplying every 2 hours). The patient was explained what to watch for I.E. Red streak, to apply ice to affected area, to use ibuprofen and TYLENOL, as needed. Also as the treatment cefadroxil 500 mg, 1 DF twice a day, orally was given. The outcome of cellulitis was reported as recovered on an unspecified date in 2015. The relatedness between cellulitis and ZOSTAVAX was not reported. Cellulitis was considered as medically significant by the reporter. All available medical records will be provided upon request. This is one of several reports received from the same source. Additional information is not expected as all information has been obtained.