Age: 42.0
Sex: M
Vaccine: PPV, FLUX
Symptoms: Computerised tomogram normal, Feeling abnormal, Headache, Injection site erythema, Injection site induration
Clinical narrative: This medically confirmed spontaneous report (initial receipt: 10-Feb-2012) concerns a 42 year old male patient, who was generally well and healthy. He had a medical history of eye surgery for ptosis and no known allergies and experiences frequent headaches. On ??-Nov-2011 (Thursday) the patient received a flu shot as part of a routine physical exam. On 19-Nov-2011 (Saturday) at 14:55 he received a PNEUMOVAX 23 intramuscularly in left arm. On Thursday night the patient developed abdominal pain. On Friday he presented to hospital with classical symptoms of appendicitis. CAT (computerized axial tomography) scan showed appendicitis. The patient had an uneventful laparoscopic appendectomy. On postoperative day #1, which was Saturday, the patient was discharged looking well and feeling well. He was given a PNEUMOVAX 23 at this point and subsequently discharged home. He felt good on Sunday but today (21-Nov-2011) he had general malaise, was feeling horrible, having a headache, generally did not feel well and had an episode of vomiting earlier that day. He had no other associated symptoms such as cough, shortness of breath, chest discomfort, sore throat or sinus pain. He was seen by a physician and was sent to the emergency room. He looked absolutely horrible, more flu like in nature. He was not complaining of any abdominal pain or any abdominal problems. In the emergency room he was noted to have an elevated white count of 16.9 with a shift. He had a normal white count with appendicitis with a small shift. His urine was noted to be clear. His chest x-ray was normal. CAT scan of his abdomen was unremarkable. His SMA7 (basic metabolic panel) revealed just a mildly elevated glucose. Physical examination was essentially benign except for a red patch on his left arm where he received PNEUMOVAX a few days ago. It was red, tender and 'somewhat' indurated. There was also a fainter area of redness along the crest of the shoulder. He was complaining of intermittent fever, chills, headache, some nausea and body aches. Although the temperature was low-grade in the Emergency Room, the patient said it was 101.6 at his house. He also reported that he frequently got headaches and this was not unusual for him. He had no back pain, flank pain, discomfort on passing his urine, diarrhoea, abdominal cramping or pain in his other extremities. He looked in moderate distress. The patient was subsequently admitted for observation. He was placed on vancomycin and ondansetron and switched over to ampicillin; UNASYN. Over the next 2 days the patient began to feel much better until he was back to his normal state. He was feeling fine. On 23-Nov-2011 the patient was discharged on amoxicillin; AUGMENTIN with heating pad to his arm and will follow up with the physician. Reporter's comments: In the hospital notes, the treating physician gave an impression of general malaise and horrible feeling with intermittent fever, chills, and nausea after a flu shot, PNEUMOVAX 23 and an appendectomy. The treating physician also gave an impression of possible bacteremia secondary to inoculation from PNEUMOVAX versus just a viral syndrome. He did seem to have a transient shedding of toxin and a transient bacteremia. The treating physician considered the inflammatory focus on the left shoulder, most likely the source of the patient's fever, chills and systemic symptoms. The treating physician also considered his could all be a local reaction to PNEUMOVAX inoculation that the patient received recently. However the treating physician was also concerned about the possibility of a bacterial superinfection, most likely a gram-positive organism, staph aureus or beta strep, which could cause the systemic symptoms the patient was describing. There was no obvious abscess present at this time.