Age: 78.0
Sex: M
Vaccine: PPV, PPV
Symptoms: White blood cell count normal
Clinical narrative: Information has been received from a health professional concerning a 78 year old male with bronchitis, chronic obstructive pulmonary disease, gastritis, prostatitis, benign prostatic hyperplasia, sleep apnea, hypercholesterolaemia, coronary artery disease, multiple unspecified heart conditions and no known drug allergies/reactions who in 1998 was vaccinated with first dose of PNEUMOVAX (dose, route and lot number not reported). On 02-FEB-2010, the patient was vaccinated SC with a 0.5mL dose of PNEUMOVAX (lot number 662270/1135Y). Concomitant therapy included doxycycline, NEXIUM, AVODART, MSD, ADVAIR, SPIRIVA, XOPENEX. The registered nurse reported that on 02-FEB-2010 the patient developed swelling, pain, warmth and redness on his arm at the injection site. The affected area was about six inches in size. The patient's swelling, pain, warmth and redness on his arm at the injection site persisted. No lab studies were performed. The patient sought unspecified medical attention. Follow up information was received from a registered nurse via medical records concerning a 78 year old male with bronchitis, chronic obstructive pulmonary disease, gastritis, prostatitis, benign prostatic hyperplasia, sleep apnea, hypercholesterolaemia, coronary artery disease, multiple unspecified heart conditions and no known drug allergies/reactions who on 02-FEB-2010 at approximately 11:00 a.m., was vaccinated SC into the left arm with possibly the second dose of PNEUMOVAX (lot number 6622700/1135Y). Concomitant therapy included doxycycline, doxazosin mesylate, NEXIUM, AVODART, MSD, ADVAIR, SPIRIVA, XOPENEX. It was reported that on 02-FEB-2010at approximately 01:00 p.m., the patient experienced severe tenderness/pain, swelling, redness. heat and inflammation around and below the injection site. The area of inflammation was 6 inches in length and 3 to 4 inches in wide. The patient was hospitalized on 04-FEB-2010. The patient presented to the emergency department with probable cellulitis. The patient said that he went to his physician on 02-FEB-2010 for a routine visit when he was given PNEUMOVAX in the anterior side of his left arm. The patient stated that within 4 hours of the vaccination his arm became red and swollen at the site of injection. The patient said that he did not sleep well in the night of 02-FEB-2010 because of pain. The next morning, 03-FEB-2010, he returned to his primary care provider (PCP) complaining of pain and swelling. He was given PERCOCET 5/325 PM, XYZAL and KEFLEX 500 mg po Q 6hrs x 10 days. The morning of admission, 04-FEB-2010, the patient was seen by his PCP and said that he felt like the cellulitis was resolving. However, the patient's physician did note that the cellulitis had moved beyond the border outlined 03-FEB-2010. The patient's physician advised him to continue with antihistamine, antibiotics, and PERCOCET as needed for pain. Then, the patient called to the physician's office at 1700 and informed him that the redness had extended down his wrist. Since the patient failed outpatient treatment with KEFLEX, the patient received one dose of vancomycin IV in ER. The patient was admitted to the family medicine service and continued on clindamycin IV to anticipate change to PO medication. The patient was reassessed in the afternoon and no significant change was seen from the morning. Overall, decreased in severity of erythema, warmth and tenderness, but distribution of erythema relatively unchanged. On hospitalization day 2 (HD#2), the warmth and tenderness was much improved, but the erythema had progressed 1 - 2 cm beyond the pen line inferiorly, while it had regressed 1 - 2cm from the superior line. The patient was discharged on HD#2 in the afternoon with clear instructions to seek medical care if the rash gets worse. He will follow-up with his PCP. The patient was discharged on clindamycin 450mg PO q6hrs x 9 more days. His COPD remained stable during the admission. The discharge diagnosis was cellulitis. The patient recovered from cellulitis on 15-FEB-2010. The registered nurse stated that she had talked with numerous other nurses who reported that they are no longer giving PNEUMOVAX CS, and not seems there are fewer reactions to the IM administration. This is one of two reports from the same source. No further information is available.