Age: 5.0
Sex: F
Vaccine: DTAP, IPV, MMR
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
Clinical narrative: Information has been received from a registered nurse and a health care professional concerning a 5 year old white female with a history of "allergy-induced ear infections" and no known allergies who on the morning of 08/15/2002 was vaccinated subcutaneously in the left arm with a second dose of measles vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(Lot # 642181/0183M)(also reported as Lot 0183U-invalid).  Concomitant vaccination on 08/15/2002 included a fifth dose of aluminum, potassium (+) diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (Tripedia)(Lot # C0725AA) intramuscularly in the right arm and a fourth dose of poliovirus vaccine (IPOL)(Lot # U1234) subcutaneously in the right arm.  There was no illness at teh time of vaccination and the patient was not currently taking any medications.  On the evening of 08/16/2002, the patient developed an injection site reaction and at 22:04, the patient presented to the emergency room with a 12cm x 8cm indurated, erythematous, warm lesion over her right deltoid.  The area was nontender, had no adenopathy, no streaking, and no shoulder or elbow involvement.  The patient did not have diarrhea, fever, cough, vomiting, adenopathy, constitutional symptoms, jaundice, nausea, chills or dizziness.  The patient had a normal appetite and normal urine output.  The patient's vital signs were reported as temperature 37.3C, pulse 103, respirations 28, and blood pressure 94/69.  The patient was diagnosed with a local reaction to the measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) in the right deltoid (reported as administered in the left arm).  At 12:20 am the patient was discharged from the emergency room and ibuprofen (Motrin) and warm compresses were suggested.  The patient was to follow-up with physician in the morning.  On 08/22/2002, the patient recovered.  On 10/29/2002, the administering nurse reported that she has "a systematic way of administering vaccinations" because she gives so many of them.  The reporter stated that she has a list of required immunizations are due, always starting with the left arm.  The reporter stated that she knows that she would have started with the measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) in the left arm.  The reporter also stated that she had noticed the discrepancy in the ER report, reporting that the reaction was in the right arm and therefore would have been the site of the aluminum, potassium (+) diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid and poliovirus vaccine and not the measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation).  However, the reporter stated that she does not know if the patient's mother reported to the ER physician that the right arm was the site of the measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation), and that possibly the mother misunderstood the sites of vaccination.  Additional information is not expected.