Age: 12.0
Sex: M
Vaccine: HPV4, MNQ, HPV4, MNQ, HPV4, MNQ
Symptoms: Rash erythematous, Rash generalised, Rash macular, Urticaria, Vaccination complication
Clinical narrative: Initial unsolicited report received from a Physician on 24 October 2016. This case involves a 12-year-old male patient who was vaccinated with first dose of MENACTRA (batch number: U5272AA, expiration date: 19 May 2017) intramuscularly and a first dose of GARDASIL (batch number: K010215, expiration date: 05 May 2017) intramuscularly (dose and site of administration was not reported for both vaccines) on 04 May 2016. Patient's Illness at time of vaccination was reported as none and Pre-existing physician diagnosed allergies, birth defects, medical conditions were reported as allergy to amoxicillin (penicillin) - rash. In 2007 patient had Tonsillectomy and adenoidectomy. Patient was lifetime nonsmoker. Patient brother had asthma. Any other vaccinations within 4 weeks of vaccinations and other medications were reported as none. On an unspecified date approximately 48 hours following the vaccination patient experienced a bright red rash all over his body. On 07 May 2016 in the morning (reported as am), three days following the vaccination, the patient developed rash, was diagnosed with erythema multiforme. After the treatment the rash got worse. On 08 May 2016, four days following the vaccination patient developed blotches at 5 pm, eyes and lips were swollen at 10 pm. On 09 May 2016 patient still had rashes. On 11 May 2016, seven days following the vaccination patient complained of foot pains, joint pains, feet hurt when walking and itchiness especially at night. On an unknown date following the vaccination patient had allergic urticarial. It was reported that patient had "rashes off and on". Patient was brought to ER (emergency room) on 07 May 2016 and 08 May 2016 (ER). On 09 May 2016 patient was seen at PCP. On an unknown date patient was hospitalized. Lab data included had allergy test and was positive for molds, horses, cattle, trees and weeds on 18 July 2016. Patient's physical examination included (VITAL SIGNS) Blood Pressure (BP): 94/58, Pulse: 62, Respiratory Rate (RR): 18. Height: 61 inches. Weight: 88 pounds, "Peak flow 250", GENERAL: Well-appearing adolescent male in no acute distress. HEENT: Sclerae are clear, No nasal discharge, Oropharynx is moist, SKIN: No hives or eczema, MUSCULOSKELETAL: No joint swelling or erythema, NEUROLOGIC: Fully oriented. Gait normal. EXTREMITIES: No clubbing, cyanosis or edema. Patient was advised to take oral dose of Benadryl every 4 hrs, Zyrtec once a day, oral steroid on 07 May 2016. On 08 May 2016 patient was given Solumedrol 80 mg IVP, Diphenhydramine 25 mg IVP, Famotidine 20 mg IVP, and was prescribed Medrol pack. On 09 May 2016 Medrol pack and Benadryl 25mg per capsule 1 capsule every 4-6 hours, Zyrtec Once a day was started. Pepcid two times a day. On an unknown date patient was prescribed Hydroxyzine 25 mg 1 tablet every 8 hours (15 tablets). On unknown date patient was given IV medications. On 08 July 2016 patient had no more rashes. On an unknown date patient recovered from the events. It was reported that Allergist recommended that patient should never receive HPV and Meningitis vaccine again. List of documents held by sender: none. Sender's Comments: This case concerns a 12 years old male experienced Erythema multiforme, allergic urticarial, eye swollen, lips were swollen, foot pain, feet hurting when walking joint pain after vaccination with MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE and HUMAN PAPILLOMA VIRUS VACCINE. Time to onset 3 days is compatible with the role of vaccine. It is reported that patient have a history of Allery to Penicillin and tonsillectomy and adenoidectomy. However more details regarding etiological work up, concurrent condition at the time of vaccination, concomitant medication, and investigation results to rule out the alternative cause are needed for complete assessment of the case. As two vaccines administered concomitantly, it is difficult to assess the role of each vaccine in particular.