Sex: M
Vaccine: PPV
Symptoms: Blood culture negative, Blood test normal, Cellulitis, Injection site erythema, Injection site pain
Clinical narrative: the patient developed redness, swelling and pain at the injection site/ symptoms were related to normal injection site reaction/swelling and redness had doubled in size; the patient developed redness, swelling and pain at the injection site/ symptoms were related to normal injection site reaction/swelling and redness had doubled in size; the patient developed redness, swelling and pain at the injection site/ symptoms were related to normal injection site reaction/swelling and redness had doubled in size/ the pain was intolerable; the patient was diagnosed with cellulitis of his left arm; the patient developed redness, swelling and pain at the injection site/ symptoms were related to normal injection site reaction/swelling and redness had doubled in size; a contaminant from the needle or the vaccine itself; it was likely poorly prepped skin; This spontaneous report was received from a pharmacist, referring to a 77-years-old male patient,  whose pertinent medical history included high cholesterol, gastric reflux and muscular dystrophy, considered concurrent conditions. His concomitant medication included rosuvastatin, diazepam and omeprazole. It was reported that the patient did not have any previous drug reactions or allergies. In addition, the patient had received pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (PREVNAR) in August 2016 (reported as "3 years ago"), considered an historical vaccine, to which he did not have any reaction.  According to the reporter, the pharmacy noticed that the patient had not "completed the series" of the pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (PREVNAR) and recommended him to get vaccination with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX 23). Therefore, on 01-AUG-2019 at 13:40 h, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX 23) intramuscularly, in the left arm, as prophylaxis (reported lot # R025296 and expiration date 08-JUN-2020 have been verified as valid; dose number and vaccination scheme frequency were not reported).   Later that evening, the patient developed redness, swelling and pain at the injection site (vaccination site erythema, swelling and pain). The patient spoke with the pharmacist that day, and  with his primary physician the next day in the morning; and both "felt the symptoms were related to a normal injection site reaction" (also reported as "normal site reaction") (vaccination site reaction); therefore, the patient was not seen nor was prescribed treatment at that moment and was recommended to "watch" only.   However, by the evening of 02-AUG-2019, the swelling and redness had doubled size and the pain was intolerable, so the patient sought for medical attention by going to the emergency room. There, he was performed " blood work/cultures" in which "nothing grew in" and was diagnosed with cellulitis in his left arm for which he was admitted into the hospital and was placed on intravenous antibiotics, one of which was vancomycin. On 05-AUG-2019, the patient was discharged from the hospital with unspecified oral antibiotics.          According to the pharmacist, the patient was told that the cultures did not grow anything specific, and that "it was likely poorly prepped skin (wrong technique in product usage process), a contaminant from the needle or the vaccine itself (suspected product contamination).   Finally, the pharmacist reported that "this was vaccine number 7 out of 10" administered, and that no other patients had any kind of adverse event.   Both, the hospital and the pharmacy have reported this adverse event to Vaccine Adverse Event Reporting System (VAERS).   By reporting time, the patient was home recovering.   According to the reporter, the occurred events were considered as life threatening. Additionally, upon internal review, the event cellulitis was determined as medically significant.