Age: 0.16
Sex: M
Vaccine: DTAPHEPBIP, HIBV, PNC
Symptoms: Apnoea, Asthma, Choking, Convulsion, Cyanosis
Clinical narrative: This report concerns an 18 week old white male who on 12/14/04 was vaccinated with a dose of HIB conjugate vaccine. On 12/14/04 the patient experienced an afebrile convulsion and was hospitalized. Subsequently, the patient recovered. Follow up information indicated that on 10/8/04 the patient was vaccinated with a first dose of HIB conjugate vaccine (lot # 647026/0657N). Concomitant vaccination the same day included a first dose of diphtheria toxoid (+) hepatitis B virus vaccine (+) pertussis acellular 3-component vaccine (+) poliovirus vaccine inactivated (+) tetanus toxoid and a first dose of pneumococcal 4 6B 9V 14 18C 19F 23F conjugate vaccine. In November 2004, at approximately 12 weeks old, the patient experienced reactive airway disease. On 12/14/04, at 12:30 PM< the patient was vaccinated with a second dose of HIB conjugate vaccine (lot # 648406/0093P) in the right thigh. Concomitant vaccination at the same time included a second dose of diphtheria toxoid (+) hepatitis B virus vaccine (+) pertussis acellular 3 component vaccine (+) poliovirus vaccine inactivated (+) tetanus toxoid (lot # AC21A008AA) given in the left thigh and a second dose of pneumococcal 4 6B 9V 14 18C19F 23F conjugate vaccine (lot # A7440F) given in the right thigh. Other concomitant medication included montelukast sodium 4mg daily for mild reactive airway disease. There was no illness at the time of vaccination. At 1:30 on 12/14/04, the patient was apneic and had a cyanotic episode. Rescue breaths were given and the patient responded quickly. The patient was taken to the emergency room where he had a new episode of bilateral decerebrate posturing followed by an apneic event. Additional information from hospital records indicated that the patient was seen in the clinic for a well child check on 12/14/04. He had some congestion, but no fever. He was vaccinated with the above vaccinations. His mother then drove him to the babysitter. About five minutes after the mother left, the babysitter noted the child to be purple and no breathing was noted. The father, who works for the Sheriff's department took the baby and the sitter to the emergency room. On the way, the sitter was giving the patient two to three breaths and he started breathing. The babysitter had also noticed his eyes rolled up and increased sounds from his throat like choking. In the emergency room, he stiffened, his eyes rolled up and his arms straightened. The patient was under the covers and they couldn't see his legs. The patient was given phenobarbital 8mg and his seizure stopped. Intubation was attempted, but the patient began to cry and fight, so it was stopped. The patient's chest x-ray was negative. His lytes were okay, white count was 17,000. He also received lorazepam. No fever was noted. RSV was negative at his visit to the clinic. The patient was admitted to the hospital with a diagnosis of new onset seizure, immunizations approximately 2 hours ago an upper respiratory infection. Upon physical examination, his color was not good, his TM's were pink bilaterally, but does have light reflect. He was sleepy but arousable. His lungs were clear to auscultation. He was moving all his extremities fine and his tone was good. the plan was to consult pediatric neurology, seizure precautions, consider a LP if his fever goes up and place him on some diphenhydramine hydrochloride. The patient was discharged on 12/15/04 and recovered. The patient was born full term at 7 pounds 11 ounces delivered spontaneous vaginal. He received hepatitis B virus vaccine at birth. He had mild jaundice, but no phototherapy. The patient's history included on hospitalization in September 2004 with Rotavirus and febrile illness (WAES0502USA03360). Convulsion afebrile was considered to be immediately life threatening. This was originally reported by a physician. No further information is expected.