Age: 30.0
Sex: F
Vaccine: PPV
Symptoms: Dyspnoea, Heart rate, Influenza serology negative, Injected limb mobility decreased, Injection site erythema
Clinical narrative: Initial and follow up information has been received from a physician and a health professional concerning a 30 year old white female patient with a penicillin allergy, anxiety and frequent headaches, a past surgical history of hysterectomy and a noncontributory family history, negative for heart disease, cancer, stroke and diabetes. She is a nonsmoker and non drinker, who on 07-MAR-2008 at 10:00, was vaccinated into the right deltoid with a second dose of pneumococcal 23v polysaccharide vaccine. Concomitant therapy included KEFLEX, MOTRIN, TYLENOL and Z-PAK. Illness at the time of vaccination was pneumonia. It was reported that the patient was a resident of the facility where she received the vaccine. On 08-MAR-2008 at 08:30, the patient developed left upper extremity cellulitis after receiving the vaccine. The patient stated "the site was painful, red and she could not raise up her arm or put any pressure on it. Cellulitis spread up my arm to the top of my shoulder, down to my elbow and around my entire arm." The patient was evaluated and treated with Z-PAK, for pneumonia, at the long term care facility. On 12-MAR-2008, the patient was seen in the emergency room with complaints of chills and shortness of breath with intermittent fever. The patient completed treatment with Z-PAK on 08-MAR-2008. She was concerned about some residual right middle lobe and right lower lobe pneumonia, treated with a dose of ROCEPHIN and placed on KEFLEX. She was okay until 07-MAR-2008, but now has started back with some chills, shortness of breath and intermittent fever. She has some body aches and chest tightness. She stated that she had the pneumococcal 23v polysaccharide vaccine on 07-MAR-2008 and has now developed erythema, redness and tenderness to the area of the injection in the left upper extremity and down to her elbow. She denies vomiting. Physical exam revealed a blood pressure of 111/80, pulse 74, respiration rate 18 and temperature 36.2 with pulse oxygen of 92% on room air. She rates her pain six to seven out of ten. Medical decision making and differential diagnosis provided was left upper extremity cellulitis and possible influenza. She was treated with one liter of normal saline wide open, two grams of ANCEF with one gram of probenecid. A complete blood count showed a white blood cell count of about 12,000. This has come down from 19,000. She had 14% bands, up from 13%. Red blood cell count was 3.78 (4.0-5.20). Influenza testing was negative for both influenza A and B. Arrangements were made for her to go to intravenous therapy and to return to the emergency room on 15-MAR-2008 at 15:00. She was given a prescription for probenecid, one gram daily for next three days, then restart KEFLEX and follow up in the emergency room. Discharge diagnosis was left upper extremity cellulitis. On 15-MAR-2008, the patient presented to the emergency room for cellulitis follow up. She had a left upper extremity cellulitis secondary to a pneumococcal 23v polysaccharide vaccine. She states that the swelling and redness has gone down. She still has some tenderness at the site of injection but feels that this has improved remarkably. She denies any ongoing fever. Her last injection of intravenous antibiotic therapy was the morning of 15-MAR-2008. The patient states that she has improved. She has not had a fever and is feeling better. She still complaints of a little hardness at the injection site. Physical exam reveals blood pressure of 116/81, pulse 73, respirations 17, temperature 37.1 with pulse oximetry of 98% on room air. Examination of the left upper extremity reveals significantly decreased erythema with some mild firmness. The rest of the review is negative. The intravenous line was pulled and she was instructed to complete the KEFLEX prescription. Discharge diagnosis indicated the upper extremity cellulitis showed improvement. The patient was discharged to home in stable condition verbalizing understanding of the discharge instructions provided and agreeable to the treatment plan. At the time of this report, the patient's outcome was improving. This is one of two reports from the same source. Additional information has been requested.