Age: 1.59
Sex: F
Vaccine: MMR, VARCEL, MMR, VARCEL
Symptoms: Contusion, Full blood count, Immunoglobulin therapy, Petechiae
Clinical narrative: Information has been received from a licensed practical nurse concerning a 19 month old female patient with no allergies or drug reactions and with a history of ear infection with ear tubes who on 05-MAY-2011, was vaccinated with the first dose of VARIVAX (Merck) (route not reported) (lot number 668973/1345Z). And vaccination with the first dose of MMR vaccine (route not reported) (lot number 668070/1059Z). The nurse stated that no other vaccinations were administered at the same office visit. Eleven days after vaccination (on 16-MAY-2011), the child developed idiopathic thrombocytopenic purpura (ITP), and was taken to the emergency room. On approximately 16-MAY-2011, the child's platelets were down to 6,000. Then, the child was transferred by ambulance to another hospital where she was hospitalized for 3 days. The patient was treated with "VZVIG" and was discharged from the hospital when her platelets rose to 28,000. The patient would be followed by a pediatric hematologist. At the time of the report the patient was recovering. Follow up information was received on 08-JUN-2011 from a physician and medical records concerning an eighteen month old female (27.4 pounds, 34.5inches) with no known drug allergies, no illness at the time of vaccination or any pre existing allergies, birth defects with history of bilateral ear tube insertion (March 2011) and several upper respiratory infections (URI) who on 05-MAY-2011 at 14:15, was vaccinated with the first dose of VARIVAX (Merck), subcutaneously right leg (lot number 668973/1345Z) and vaccination with the first dose of MMR vaccine, subcutaneously left leg (lot number 668070/1059Z). A pediatric hematology oncologist reported that on 19-MAY-2011, a previously healthy female had received prior VARIVAX (Merck) and MMR vaccine at her primary care physician's office. It was reported that the patient did not have any problems at that time, patient was not on any medication. Approximately five days prior to hospital admission the patient had upper respiratory symptoms with low grade temperature, but no real fever that had resolved. The upper respiratory symptoms with low grade temperature, but no real fever that had resolved. The upper respiratory symptoms with low grade temperature lasted for a couple of days and two days prior to presentation the family noted that the patient had developed a rash all over and multiple bruises. The patient also had a tongue injury while had brushed her teeth and her tongue bled but stopped spontaneously. The patient had not experienced any other bleeding besides the tongue which was no longer bleeding. The patient was seen at her primary care physician's office the day prior to admission and her platelet count was 6 thous/cmm. The patient was sent to the emergency room and it was noted the patient had multiple areas of ecchymosis on face, torso and extremities. Repeat platelet count was 5 thous/cmm, elevated serum lactate dehydrogenase 534 U/L, slightly elevated chloride 112 mEq/L, alkaline phosphatase elevated 250, albumin elevated 4.8 g/dL and blood urea nitrogen 9 mg/dL. The patient was then transferred to another hospital to inpatient pediatric unit for iodiopatic thrombocytopenic purpura. No family history of bleeding problems. The patient received Intravenous immunoglobulin (IVIG) overnight that was tolerated well. On examination the physician noted patient was alert in no apparent distress with numerous petechiae and bruises scattered diffusely on her body, the greatest concentration on her lower extremities. The physician assessment: patient with thrombocytopenia consistent with iodiopatic thrombocytopenic purpura. The physician discussed with the patient's father the history of iodiopatic thrombocytopenic purpura and that Intravenous immunoglobulin (IVIG) raises platelets but no actually fix the underlying problem. The patient's father was told that approximately 90% of children her age with iodiopatic thrombocytopenic purpura will resolve by six months and that she will be followed over time regarding platelets. On 23-MAY-2011 the patient's platelet count was 28 thous/cmm. At the time of this report the patient had not recovered. All available medical records will be provided upon request. Additional information has been requested.