Age: 1.5
Sex: F
Vaccine: DTP, HIBV, MMR, OPV
Symptoms: Rash maculo-papular, Urticaria
Clinical narrative: Information has been received from a physician concerning an 18 month old white female, noted to have had a slight cough and possible early upper respiratory infection at the time of vaccination and allergies to milk products and strawberries, who on 10/17/1991 was vaccinated with one dose of MMR II, in the right leg (lot 50897/1142T). Concomitant therapy, that same day, included one dose of diphtheria toxoid/pertussis vaccine/teta, administered in the left vastus lateralis (lot 1K21074); one dose of Hibtiter, administered in the right vastus lateralis (lot M185H2); and one dose of oral poliovirus vaccine (lot 308949). There were no other concomitant medications. The pt was examined by the physician on the day of vaccination, 10/17/1991, and was noted to be in no acute distress, with "no problems recently." She was being breast-fed at that time and was noted to be one of a set of twins. The physical exam was normal, except for a "slight cough last few days," which was diagnosed as a possible early URI. It was reported that despite this possibility, the child's mother preferred the vaccinations be given, that day. It was noted that the child did not received her 15 month immunizations or check-up. On 10/25/1991, the pt's mother called the physician's office to report that the pt had a rash on her trunk that was "red and splotchy," a temperature of 100 degrees F, and was "cranky." "Yesterday," on approximately 10/24/91, it was noted that the rash was decreased and that "today," on approximately 10/25/91, the rash was on the pt's legs, abdomen, face and neck. It was further noted that the physician's office notified the emergency room that the pt was "coming over for stat blood work." On approximately 10/25/91, the pt's mother notified the physician's office that the child was taking "hydroxyzine syrup for itch and (prednisolone) (Prelone) syrup for rash." At that time, it was also reported that the pt appeared unsteady, staggering, was not sleeping well, refused to take naps, and was fussy. On 10/26/91, the pt was examined by the physician, who noted that the rash developed on her chest, abdomen, and arms, "in the last two days" and was on her face, neck, arms, abdomen, and back, at the time of exam. It was reported that she had been having some bruising in her lower abdomen "where the rash is more confluent." At that time, it was also noted that she had been running a fever (temp 99.1 deg F) and that her nose was congested. She was diagnosed with "hives (etiology unclear), easy bruising, and otitis media." Otherwise, the exam was noted to be normal. The physician noted that "possible complications here may be allergic reaction to MM." The pt was treated with Augmentin "125 per tsp, one tsp tid five ounces, with food for the ear infection," "to be started in one to two days," and Benadryl 12.5mg qid for itching and rash. On approximately 10/26/91, CBC, chemistry profile, and ESR were obtained. On 10/26/91, she was diagnosed with erythema multiforme. At this time, the physician noted "may be allergy to MMR, but hard to say." Additional info has been requested.