Age: 23.0
Sex: M
Vaccine: ANTH, SMALL, YF
Symptoms: Dizziness, Flushing, Headache, Hypersensitivity, Malaise
Clinical narrative: Member experienced fever and vomiting, 3 1/2 hours after receiving Typhoid #1 (lot U0704-2) in 12/2002; this was not reported to medical staff. Member is adopted and does not know of any other significant history. On Thursday, 2/20/03, received this following immunizations: Anthrax #1 (FAV0gg, Right Arm (deltoid, SC); Yellow Fever #1 UB315AA, Right Arm, deltoid SC); Smallpox #1, 40020071, Left Arm, deltoid, 3 jabs); IPPD #2, (C0982BB, Left Forearm, ID). His supervisor called the clinic on Friday, 2/21/03 at 16:45, to report that the pt notified him Friday morning that he had been given the wrong immunizations and had experienced a reaction with high fever. I contacted the pt on Friday afternoon and the following is his account of the events of 2/20/03: According to the pt, after receiving the Anthrax and YF vaccines, he was waiting in line to receive the Smallpox vaccine when he began to feel lightheaded. He sat down than then placed his head between his knees. At the point he was helped into the First Aid Room and placed on the stretcher to lie down. Once he recovered and showed no signs of anaphylactic shock, he was given his Smallpox vaccination, while lying down. No longer feeling lightheaded, he continued processing and received his IPPD in the classroom. As he was checking out of the clinic, one of his fellow unit members asked him if he was okay because his face appeared flushed. He explained to them what happened. This unit member then told the pt that the clinic had made a mistake in given him 2 live viruses and that's probably why he became lightheaded. He was quite distressed with this statement and left the clinic with addressing this issue with a medical staff member. The pt continued that later on Thursday evening, he began to feel ill and developed a fever. His fever rose to 103F (oral). It was at this point that his wife insisted that he go to the ER to be seen. The pt went to ER where he was evaluated and prescribed Motrin for the DX of inflammatory response to IZ. He notified his supervisor on Friday AM, 2/21/03, that he had been given the wrong IZ's and had experienced a reaction with high fever. The pt did not come to the base on Friday because he was not feeling well. He stated that he was not instructed to come to the clinic or contact the clinic for further evaluation. After hearing the pt's account of events, I inquired as to how he was feeling today. He stated, "I am having events of fever periodically. I can be okay one moment and then I will be very hot with fever. This will last about an hour or so and then go away. I am still taking the Motrin around the clock, but this really concerns me." I first, assured the pt that he received the correct vaccines and the 2 live vaccines that were administered had prior approval to be given together. The MD and I had confirmed before processing began. I then informed the pt that a follow-up appt. with a provider for further evaluation. The pt verbalized understanding and stated that he would do whatever was needed. Upon learning that this Urgent Care is a first-come service center, I called the pt back and informed. He stated that he would go to be seen this evening and update me in the morning. I passed this info on to the MD. On Saturday, 2/22/03 at 14:00 hours, I spoke with the pt and he stated that 2 physicians saw him and agreed that he was having an inflammatory response to the vaccines that he received. They also identified 4 red bumps (2 on his nose, 1 above his left eyebrow and 1 on his back. According to the pt, he has never had acne, so the physician felt these bumps were also in association to the inflammatory response. The pt was advised to take Tylenol vs Motrin and return to the Urgent Care Clinic if any other problems occurred. I asked the pt how he was feeling the next day and he stated, I am feeling somewhat better, but still having fevers. I asked when was the last fever and were there any other symptoms? He replied, "It was 05:00 this AM. The reason I remember is because I woke up feeling very hot and looked at the clock. I also had a throbbing headache at the same time. This all lasted no more than an hour, then the fever went away. I do still have a mild headache, but nothing like what I had this AM. I decided to go back to taking Motrin since I have not felt as good since beginning the Tylenol". I told him that taking the Motrin was okay. I told him to please follow-up with me if he should develop a rash, experience a continued throbbing headache that will not go away or any other issues or concerns. He agreed. I spoke with the pt, this afternoon, and he reports that he has not had any more fever or other symptoms of inflammatory response. The red bumps have gotten smaller and the 2 on his nose are almost gone. No other rash has appeared. The pt is still taking the Motrin and will continue through tomorrow when he is seen at the clinic.