Age: 9.0
Sex: M
Vaccine: PPV, UNK
Symptoms: Injection site induration, Injection site pain, Injection site swelling, Injection site warmth, Lethargy
Clinical narrative: Body aches; When he got home he was complaining of site pain / any pressure was very painful; he received both vaccines in the same arm since he needed to be held down to receive the injections; The mother reports the reaction looked like cellulitis because it was red, indurated, hot and growing; Injection site celullitis; the injection site was bruised; lethargic; This spontaneous report was received from a nurse who was the mother of the patient, referring to a 9-year-old male patient. The patient's concurrent conditions included a drain due to recurrent perirectal abscesses. He had a history of recurrent infections where he complained of joint pain, leg pain and body aches when the infection was bacterial. He also had a history of some "titers" that showed he was not immune to pneumonia or tetanus (+) diphtheria (+) pertussis (reported as "TDap"). Concomitant medications were not provided.   On 21-OCT-2019 at 16:30, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23) in the deltoid (dose, frequency, route, lot/batch # and expiration date were not provided) for prophylaxis, at the same time, he was vaccinated with tetanus (+) diphtheria (+) pertussis (reported as "TDap") in the deltoid (dose, frequency, route, lot/batch # and expiration date were not provided) for prophylaxis, this vaccine was administered just 1 inch apart from the previous one, in the same arm (unspecified) since he needed to be held down to receive the injections (product administered at inappropriate site). The patient did not have any active infection at the time of vaccination.   On the same date in the evening, the injection site was bruised (vaccination site bruising). On 22-OCT-2019, the injection site was a little red and puffy which the mother considered normal injection site reactions; at 15:00, the mother was called to pick him up from school program due to headache, body aches (pain), chills and fever. The injection site at this that was also very red and swollen but maybe only "3 by 3". The site was getting hot and red. When he got home, he was complaining of site pain (vaccination site pain) so ibuprofen and acetaminophen (TYLENOL) were given to treat the pain. He was also given an ice pack to reduce swelling, redness, warmth and pain. Any pressure was very painful. At about 23:00, he had the maximum dose of ibuprofen and acetaminophen (TYLENOL) and spike a 102.9 (units not provided) fever. He was given a tepid bath and the fever reduced to 102.1 (units not provided). He was given acetaminophen (TYLENOL) 15 minutes early which reduced the fever until 23-OCT-2019 at about 03:00, when his fever was 102.8 (units not provided) and climbing so he was given ibuprofen and acetaminophen (TYLENOL) an hour early. Around 05:30, his fever broke, and he developed sweats. The acetaminophen (TYLENOL) and ibuprofen were continued to prevent fever, but the injection site was growing from the size of a plum to the size of a baseball. On the same date, he was given 25mg of diphenhydramine (BENADRYL) to see if this would work and help, and hydrocortisone cream was putted on the injection site but the diphenhydramine (BENADRYL) and hydrocortisone did nothing. On 24-OCT-2019, he was seen by his primary care provider (PCP) who stated the reaction was local and was now about "6 by 7". The mother thought he was having a systemic reaction due to he was having malaise, body aches, headache, and being lethargic (lethargy). The mother reported the reaction looked like cellulitis (cellulitis - injection site cellulitis) because it was red, indurated, hot and growing. No treatment was given at that time. On the evening of that day, he started spiking fevers again over 102 (units not provided) so he was being treated with acetaminophen (TYLENOL) and ibuprofen (MOTRIN). The injection site reaction was also still growing. Therefore, on the same date, the reaction was "10 by 12". The doctor still did not think it was cellulitis but started him on cefalexin (KEFLEX) twice daily. The mother marked the injection with the largest point being "14.5 by 12". On 25-OCT-2019, the patient's fever broke again, and the injection site started to shrink within 12 hours of starting cefalexin (KEFLEX). At the time of the report (26-OCT-2019), the injection site reaction was shrinking, and he woke up for the first morning since vaccination without a fever. He was scheduled to received titers again in 3 weeks. It was unknown if he would continue pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23) as he continued to experience symptoms though the symptoms were improving.   The outcome of cellulitis, vaccination site pain, pain, vaccination site bruising, injection site cellulitis and lethargy was reported as recovering.  The causality assessment between the events and pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23) or tetanus (+) diphtheria (+) pertussis (reported as "TDap") was not reported.   Upon internal review, the event of cellulitis was considered to be medically significant.