Age: 1.6
Sex: F
Vaccine: DTAP, IPV, PNC
Symptoms: Febrile convulsion, Lethargy, Loss of consciousness, Pyrexia, Tremor
Clinical narrative: The patient presents with quite a high fever of 104 post-vaccination.  Preceding this was doing quite well.  No other obvious signs of infection noted.  The patient does not appear to be bacteremic.  I have very low suspicion for meningitis.  The patient is interactive, nontoxic-appearing, has no meningismus.  Urinary tract pathology is a consideration and urine will be checked here, but I think the overwhelming likely source of the fever is a post-reaction to the DTP.  All three vaccines she received are dead viruses, but nontheless she could have a systemic reaction post-vaccine, which she has had in the past.  I saw no evidence of other serious bacterial infections such as bacteremia, cellulitis, septic joints, nor does she had any other specific URI complaints to correlate with this viral process.  Because of the episodes, a repeat CBC and blood culture will be obtained, a urine is able.  I do not believe lumbar puncture is necessary.  The patient was very interactive here, was playful and taking per mouth.  I spoke with the pediatrician on call for MD who concurs.  He believes this is likely secondary to DPT.  Antibiotics will not be administered, given that this is likely a post-vaccine reaction, although despite the high fevers there is no elevated white count and the patient appears well.  I do not believe there is any source for which I should prescribe antibiotics.  The family feels comfortable with this.  They plan on not continuing the DPT at this point.  They will follow up with their pediatrician in the next 48 hours if there are any concerns or ongoing fevers.  IMPRESSION: Febrile seizure; post-vaccination febrile episode, likely systemic response.  Treatment includes follow up with pediatrician in the next 48 hours.  Tylenol or Motrin.  Return if increasing complaints, shortness of breath, lethargy, not eating or worse.  The patient was discharged in improved condition.   The patient is an 18 month old female vaccinated yesterday and presents today with a febrile seizure.  The patient has had one previous episode where she was febrile post-vaccinations approximately a year ago above 102-103.  She also had a previous febrile seizure in July of this year after a high fever was noted.  She was evaluated with both blood and urine samples which were unremarkable and was discharged home.  The patient was doing very well until yesterday.  She received her vacicnes, DTAP, IPV, PCV7.  The mother states she "usually runs fevers after her shots."  She was fine until last evening when she developed a temperature of 101.8.  This morning the mother thought she did not have a fever, but then they went to some type of Thanksgiving feast and the mother was driving home in the car and heard some gurgling.  She looked back and the patient's head had rolled back and she was "shaking all over."  This occurred for approximately 30 seconds to a minute and she was unconscious during this.  Afterward she was lethargic for perhaps 5-10 minutes.  This was identical to the previous febrile seizure she has had.  Now, the patient is interactive and taking per mouth, does not appear to be toxic.  Preceding this there were no other infectious complaints.  No fevers or coughs.  No rhinorrhea.  No obvious ear tugging.  No abdominal complaints.  No nausea, vomiting or diarrhea.  No rashes.  No trauma.  No medications were ingested, to the mothers knowledge.