Age: 0.3
Sex: M
Vaccine: DTAP, HBHEPB, OPV
Symptoms: Fatigue, Gastrooesophageal reflux disease, Neurological examination normal, Staring
Clinical narrative: Information has been received from a registered nurse via medical records concerning a 5 1/2 month old male patient with no known drug allergies, no surgical history and a medical history of jaundice for which he was rehospitalized at age 5 days and received photo therapy. On 17-JUL-2000 and 21-SEP-2000 the patient was vaccinated intramuscularly into the thigh with the first and second dose of COMVAX (Lot# first dose 634057/0300K, second dose 635129/0785K). Concomitant therapy included the first and second dose of DTaP (Lot # first dose 40276CA, second dose U0299BA), and the first and second dose of OPV (lot # first dose R1346, second dose T0120). On 08-NOV-2000 the patient was seen for neurologic consultation for possible seizures. The patient had a total of "six spells," over the past month (approximately 06-OCT-2008) which all occurred during or immediately after breast feeding in a reclined position. On 11-Jun-2001 the third dose of COMVAX (lot#638593/1823K). Concomitant suspect therapy administered on 11-Jun-2001 included a dose of VARIVAX (MSD) (Lot# 637973/1884K). Concomitant therapy administered on 11-JUN-2001 included PREVNAR. It was also reported by a nurse that the last time the child was seen in the office was in December 2002, and it was recommended that the child see a physical therapist for motor skills development delay. On 06-Feb-2008 the mother of the child called the office to find out if any of the vaccines contained mercury. At the time of this report the outcome was unknown. It was also reported there was no family history of seizures or gastrointestinal disturbance. No product quality complaint was involved. the patient's vaccine administration record indicated that on 13-FEB-2001 the patient was vaccinated in the right thigh with the third dose of diphtheria and tetanus toxoids and acellular pertussis vaccine (Lot # UC341BA) and into the left thigh with the first dose of PREVNAR (LOT # 472554). On 03-APR-2001 the patient was vaccinated in the right thigh with the second dose of PREVNAR (lot # 474730). On 28-SEP-2001 the patient was vaccinated in the left thigh with a first dose of MMRII (MSD) (Lot # 636393/0016L), and on 29-NOV-2001 was vaccinated into the left thigh with the first dose of FLUVIRIN (Lot # E04821KA), a third dose of  OPV-MERIEUX (Lot # T1446), and into the left thigh with a fourth dose of TRIPEDIA (Lot # 00537CA). On 07-JAN-2002 and 14-OCT-2002 the patient was vaccinated in the left thigh with a second and third dose of FLUVIRIN (Lot # second dose E04821KA, third dose EF3702HA). The neurologist impression was that the patient's prandial and post-prandial staring spells were most likely to be tiredness with shift into a sleep state or perhaps mild gastro-esophageal reflux (he is also supine and post prandial). Spells are occurring less frequently than initially. I suggested that the patient be fed in a more upright posture. I doubt that the minor laboratory abnormalities seen on the metabolic panel indicate real abnormalities, so I simply suggested repeating the metabolic panel when he is due for his next blood count. If the spells should begin to occur more frequently we might consider in-patient pH probe and EEG simultaneous monitoring for 1-2 days in the hospital. Neurologic follow up is prn. Upon internal review, possible seizures was considered to be an other medical important event. Additional information has been requested.