Age: 1.57
Sex: F
Vaccine: FLU3, HEPA, FLU3
Symptoms: Cough, Dysphonia, Ear pain, Impetigo, Influenza virus test negative
Clinical narrative: Initial report received from a healthcare professional on 14 February 2014. An 18-month-old female patient concomitant medications and medical history was not reported received an intramuscular FLUZONE (batch number: U4696EA) in left thigh on 10 February 2014. The patient was observed to have "small area of impetiago" impetigo on left knee. On 13 February 2014, patient experienced red, swollen left leg with vesicular rash over entire leg. It was stated that it looked like impetigo or herpetic. Reporter stated it could be impetigo but has never seen impetigo in that area before and covering that larger area. On 14 February 2014, patient's rash got worse. Patient received antiviral and acyclovir as the corrective treatment. Relevant laboratory tests were not reported. List of documents held by sender: none. Follow up information received on 23 May 2014. The patient visited the clinic on 18 February 2014 and on 26 February 2014. The patient had a family medical history of Type 2 Diabetes. The patient had no exposure to tobacco or smoke. The patient reported allergies (rash) to CEPHALEXIN. It was been reported patient had been suffering from common cold, impetigo, miliaria rubra tropicalis, other apnea of newborn, rash, underweight, unspecified respiratory abnormality and wheezing. Corrective treatments patient undergone included: Diphenhydramine HCl: 12.5 mg per 5 ml syrup (1 teaspoon by mouth q 6 hr for rash). ZOVIRAX 5%: topical ointment, q 3 h, 6 times daily for 7 days. Bacitracin: 500 units per gram topical ointment. Acyclovir: 200mg per 5ml oral suspension, 1 tablespoon qid for 5 days. Examination results on 18 February 2014 are as follows: General: Well developed; well nourished; well groomed; no apparent distress; playful; smiling; NT/WH/NAD. Appears well. Head: normocephalic, atraumatic. Neck: neck supple. Constitutional: Positive for well hydrated. Negative for acute distress, fatigue or fever. Eyes: Negative for eye drainage, lids and conjunctiva are normal; PERLA; EOMI. E/N/T: Negative for ear pain, ear drainage and nasal congestion. Respiratory: Normal respiratory rate and pattern with no distress, negative for acute cough, dyspnea (associated with respiratory illness), hemoptysis and wheezing. Gastrointestinal: Negative for anorexia, diarrhea, nausea, abnormal voiding and vomiting. Musculoskeletal: Negative for cyanosis of extremities, edema, limb pain, joint swelling and weakness. Integumentary: Positive for rash. Negative for pruritis. Neurological: Negative for abnormal tone. Skin: Circumferential area around LLE, thigh now with scabbed-over, dry rash without erythema, edema, pain or heat. No d/c or weeping. Appears to be faded in some areas. Generally spares back of leg. Neurologic: Cranial nerves II-XII grossly intact, patient appears playful and active. Vitals of patient: weight =9.7kg, temperature=97.6 F (axillary). The patient visited clinic again on 26 February 2014 since patient had vomiting episodes since previous night as soon as she eats. Examination results on 26 February 2014 are as follows: General: well developed, well nourished, no apparent distress. Head: normal. Eyes: lids and conjunctiva are normal. Constitutional: positive for fever. E/N/T: positive for ear pain, nasal congestion, frequent rhinorrhea, hoarseness and sore throat, the left TM is red, oropharynx, erythematous tonsils. Cardiovascular: negative for cyanotic spells. Respiratory: positive for acute cough, negative for wheezing. Normal breath sounds with no rales, rhonchi, wheezes or rubs. Cardiovascular: normal rate and rhythm without murmurs; normal S1 and S2 heart sounds with no S3, S4, rubs or clicks. Integumentary: positive for rash. Lymphatic: no enlargement of cervical nodes. Skin: no ulcerations, lesions or rashes. Neurologic: patient appears playful and active. Vitals of patient: weight= 22.6 lbs, temperature: 98.2 F, BP: 83/40 mmHg. P: 120 bpm (left arm(BCP cuff), lying); R: 20 bpm. Laboratory investigations revealed positive for streptococcus test and negative for influenza A and B tests. Physician prescribed following medications: For vomiting: ZOFRAN 4mg/5ml oral solution 0.5 ml po q8 prn n/v for 2 days, refills: 0. PEDIALYTE solution oral solution 4 ounces po tid for 2 days #240 (two hundred and forty) oz, refills: 0. For L otitis media: Azithromycin 200mg / 5ml oral suspension 1/2 teaspoon po today then 1/4 teaspoon po for four day. OS for 5 days. Refills: 0. For strep tonsillitis: TYLENOL, children's 160mg/5ml oral suspension 1 teaspoon po 4-6 prn fever #4 (four) oz refills: 0. Documents held by sender: none.