Age: 65.0
Sex: F
Vaccine: PPV
Symptoms: Agitation, Coma, Confusional state, Convulsion, Haematocrit decreased
Clinical narrative: Information has been received from a pharmacist concerning a 65 year old female who on 03-JAN-2002 at approximately 14:00 was vaccinated with a dose of Pneumovax 23. Approximately 10 hours later, at approximately midnight, the pt was taken to the ER because of a seizure. Her seizure was controlled in the ER with benzodiazepines and she was admitted to the hospital overnight for observation. It was noted that the pt was afebrile when she was vaccinated, admitted to the hospital and during her hospital stay. She had no additional seizures and was discharged the following day with a diagnosis of "first time seizure". The pharmacist noted that no other diagnosis was made and that the pt recovered from her experience. Follow up information received from a physician and medical records indicated that the patient had an episode of tonic clonic activity followed by an apparent post ictal state. It was noted tha there was no incontinence. The patient's sister reported that she discovered this event while the patient was sitting in a chair after she had taken a shower. She stated that the patient was not concscious during the tonic clonic activity, and that the patient did not respond to her calling her name. Following the tonic clonic activity, the patient became limp and gradually became more responsive. She was, however, confused and agitated adn seemed somewhat confused upon arrival at the emergency room about 40 minutes after the episode. A physical examination at the hospital revealed that the patient was alert and oriented and was in no distress. The exam was unremarkable except for a very vague mass in the adipose tissue on the patient's left arm which felt like a lipoma (patient scheduled to follow up with a physician regarding mass). She was diagnosed with a new onset of tonic clonic seizures. The patient was started on phenytoin and discharged home. It was reported that she would be scheduled to see a Neurologist for the new onset of seizures and she was instructed not to drive, climb, swim, or do any other activities where a suddes los of consciousness could result in significant harm to herself or others. Althought the patient had no prior history of tonic clonic seizures, she later related a history of signs and symptoms of a partial complex. It was noted that there was a family history of breast cancer (patient's sister). On 1/3/02 the patient's hematological workup (prior to any meds, while hospitalized) yielded the following significant findings: WBC low, RBC low, HCT low to lowering her white blood cell count and her anemia. It was noted that the patient was started on carbamazepine and that B-complex supplements were needed. It was also reported that the patient looked dehydrated and needed to increase her fluid intake. On 1/31/02 the patient's carbamazepine level was 7.9. Significant results of a hematological work up on 2/7/02 were as follows: WBC low Critical, RBC low, hematocrit low, HCH high, Lymph high, Gran low, Mono, number low and Gran. number low. It was noted ont he patient's report that her phenytoin was in normal range, but that her white blood count was still low, and that since the patien's granulocytes had decreased, the patient's carbamazepine would be stopped. A change in medication was to be implemented when the patient saw her physician. A hematological work up on 2/14/02 after the carbamazepine had been stopped and the patient remained on only phenytoin yielded the following significant results: WBC low, RBC low, HGB low, HCT low, RDW low, LYM low, CO2 high and ALT high. See laboratory section for normal laboratory findings. Additional information is not expected.