Age: 24.0
Sex: F
Vaccine: HEP, HIBV
Symptoms: Glomerular filtration rate normal, Graft versus host disease in gastrointestinal tract, Graft versus host disease in skin, Granulocyte count, Haematocrit increased
Clinical narrative: This case was reported by a other health professional via other manufacturer and described the occurrence of fever in a 24-year-old female patient who received Hib vaccine. Co-suspect products included Hepatitis B vaccine and dTpa vaccine. The patient's past medical history included nightmare (due to treatment from CYMBALTA), urinary tract infection (due to group B strep treated with AUGMENTIN), pneumonia fungal (treated with voriconazole), migraine aura (exacerbated by cyclosporine), syncope, hypertension (possibly medication-induced), seasonal allergy, nephrolithiasis and upper respiratory tract infection. Concurrent medical conditions included acute myeloid leukemia (treated with ibrutinib), graft versus host disease (stabilized by concomitant prednisone 15 mg every other day), depression, anxiety (treated with ATIVAN), hypogammaglobulinemia, urge incontinence, dysphagia, joint range of motion decreased (with musculoskeletal or joint pain, with difficulty in mobility (arising from chair or moving in and out of a car)) and vitiligo. Concomitant products included PREVENAR 13, Poliovirus vaccine, VFEND, ZOLOFT, voriconazole and oxycodone. In April 2016, the patient received Hib vaccine and Hepatitis B vaccine. On an unknown date, the patient received dTpa vaccine at an unknown dose. In April 2016, an unknown time after receiving Hib vaccine and not applicable after receiving Hepatitis B vaccine and dTpa vaccine, the patient experienced inappropriate age at vaccine administration. On an unknown date, the patient experienced fever. On an unknown date, the outcome of the fever and inappropriate age at vaccine administration were unknown. It was unknown if the reporter considered the fever to be related to Hib vaccine, Hepatitis B vaccine and dTpa vaccine. Additional details were provided as follows: The age at vaccination was not reported. The reporter was only the prescribing healthcare professional. The reporter's contact information was available at GlaxoSmithKline or sub contracted party. The patient's past medical history and associated conditions with the transplant procedure included DVT/PE during previous hospitalization for a transplant procedure treated with heparin and subsequently shifted to XARELTO, thrombotic microangiopathy, possibly medication-induced seasonal allergies. The patient's underlying conditions included acute myeloid leukemia, currently in 2nd remission after undergoing myeloblative allogeneic mobilized blood sibling-matched transplant and currently concomitantly treated with IMBRUVICA. The patient remission was from the treatment of Idarubicin and Cytarabine. Also, Graft-versus-host disease of the gastrointestinal tract and skin, with current manifestations of eosinophilia and basophilia stabilized by concomitant Prednisone 15 mg every other day, weekly Phototherapy of unspecified dosage, and topical Triamcinolone cream. This condition was previously treated with cyclosporine. The condition manifested as skin lesions, blisters, and ulcers on the chin, abdomen, and extremities treated by dermatology healthcare professional and home wound care. The conditions associated with concomitant steroid exposure were leukocytosis, proximal myopathy, and polycythemia, obesity, confounded by excessive caloric intake. The patient undergone many lab tests, significant results from relevant lab tests included negative biopsies via esophagogastroduodenoscopy (EGD), and pathology results revealing moderate chronic Graft-versus-host-disease (GvHD) of gastrointestinal tract and skin. The patient received TDAP, PREVENAR 13, Hib vaccine, killed poliovirus and recombinant  hepatitis B vaccine. She had a very robust response to the vaccine with fever. An adult patient received a dose of Hib vaccine, which led to an inappropriate age at vaccine administration. They would continue to hold off on further vaccinations at the present time since she was unlikely to receive benefit as she remains immunosuppressed with Prednisone and subcutaneous Ig. The patient was concomitantly treated with Voriconazole and BACTRIM as prophylaxis pneumocystis Jiroveci, Oxycodone for pain, unspecified tricyclic antidepressant for neuropathic pain, Monthly intravenous Ig for a resolved chronic cough.