Age: 50.0
Sex: F
Vaccine: MMR, MMR, MMR
Symptoms: Rash, Rubella antibody negative
Clinical narrative: Information has been received from a nurse referring to a 50 year old female patient with allergy to azithromycin (reaction unspecified). On an unspecified date, the patient had titers drawn which showed no immunity to rubella. No past vaccination history available. In response to negative titers, on 18-MAR-2015 the patient was vaccinated with M-M-R II, lot # K010318, expiration date: 22-JUL-2015, 0.5 ml, subcutaneously. On 20-MAR-2015, the patient developed rash on her hands, face and arms. The patient was sent to the Emergency Room for evaluation and no treatment information was available. The patient was not admitted to the hospital. At the time of the report, the outcome of the event was unknown. Follow up information was received on 14-MAY-2015 from a health care provider and a VAERS E-report (temporary E-report number E-89617). A 50 year old female with allergies to E-MYCIN and Z PAK (both, reaction not specified) and a history of M-M-R II given on 27-APR-2007 by another provider. Concomitant medications included: FLONASE, levothyroxine, omeprazole, estradiol, SINGULAIR and loratadine. On 18-MAR-2015, 12 pm, the patient was vaccinated with M-M-R II, (lot number KC10318, expiration date 22-JUL-2016), 0.5 cc subcutaneous in the right arm. No illnesses were reported at the time of vaccination. On 18-MAR-2015 afternoon, the patient stated itching to her left hand began. No rash was reported. On 19-MAR-2015 am, the patient woke up with a headache and rash on her nose, cheek and left hand. On 20-MAR-2015 at 9:45 am, the patient presented to employee health with a red rash to her left cheek, nose and around her mouth. She had itching to her scalp and a rash with blisters to her left hand. The patient reported the itching was intensifying and felt achy along with having a headache. The employee stated her voice felt raspy and maybe needed her inhaler; however, the patient was reported as not in acute respiratory distress. Her respirations were easy and regular. The patient was sent to the emergency department. On 25-MAR-2015, the patient saw her primary care physician after her rash worsened and became more generalized despite completing a MEDROL pack prescribed in the emergency department. The patient was referred to a dermatologist where she received a steroid shot and unspecified cream. The patient reported that her physician said her rash may be related to the vaccine but was not certain. The patient reported her rash was generalized to her extremities, trunk and face with weeping in some areas. The patient's outcome was reported as resolved (date not provided). Follow up information was received on 14-MAY-2015 from medical records concerning a 50 year old female. Concurrent conditions included: nonsmoker, asthma, hypothyroidism, osteoarthritis, hyperlipidemia, allergic rhinitis, spondylolisthesis of C5-C6, cervical radiculopathy, bronchitis, solitary pulmonary nodule, esophageal reflux, hearing loss, allergy to lactose, and food allergy to mango. The patient has a medical history of total abdominal hysterectomy (2008), disc placement in neck (2011) and ablation of dysrhythmic focus. The patient has a family history of hypertension, hyperlipidemia, colon polyps, osteoarthritis, stroke, chronic obstructive pulmonary disease and hearing loss. Concomitant therapies included albuterol, FLONASE, ADVAIR, NEURONTIN, MUCINEX, SINGULAIR, BACTROBAN, PRILOSEC, CLARITIN and PRAVACHOL. On 20-MAR-2015 at 9:45 am, the patient presented to her employee health with now having a rash all over her hands where a few were blistered. She had received a M-M-R II on 18-MAR-2015. The patient complained of feeling hot and sweaty. Her vital signs included a temperature of 98.8, blood pressure of 130/91 and pulse of 92. The patient was given two 20 mg tablets of BENADRYL and the patient took 1 tablet. The patient remained in the physician's office to monitor symptoms. The patient reported she has asthma and may need her inhaler. The patient was sent to the emergency room for rash and potential allergic reaction. On 20-MAR-2015 at 11:30 am the patient was assessed at the emergency department for rash to bilateral hands and face after M-M-R II given on 18-MAR-2015. The patient's rash was noted as urticarial and erythematous. The patient denied changes to soaps, detergents, make up or household objects. She denied shortness of breath, chest pain, cough, wheezing or sensation of throat closing. The patient was assessed with rash (also reported as drug rash) and possible (also reported as likely) allergic reaction to MMR vaccine. The physician's plan was treatment with MEDROL Dose Pack and BENADRYL. The patient was discharged to home in stable condition. On 25-MAR-2015 the patient was called by the physician's employee health office in follow up. The patient was not returning to work as per instructions until her rash was dry and resolving. On 01-APR-2015, the patient was seen by a physician's employee health office for clearance to return to work. The patient was treated by a dermatologist on 30-MAR-2015 with further steroid treatment. The patient reported that her rash/hives to face and trunk have resolved. The rash to her hands was scabbed and was without drainage or erythema. The patient reported the physician was unsure of cause of her rash/hives and recommended the patient to follow up with an allergist for any future reaction. The patient reported she feels well and able to complete her job duties. The patient was cleared to return to work. The physician indicated that this event required medical intervention. Upon internal review, rash/drug rash was considered to be medically significant. All available medical records will be provided upon request. Additional information has been requested.