Age: 49.0
Sex: F
Vaccine: HEPA, PPV
Symptoms: Injection site pain, Injection site reaction, Injection site warmth, Laboratory test abnormal, Lymphadenopathy
Clinical narrative: Information has been received from a nurse practitioner concerning a 49 year old female with a history of hypertension, polycythaemia Vera and allergies to soy products who on 12/09/2005 at approximately 2:00 pm was vaccinated with a first dose of Pneumococcal 23v polysaccharide vaccine 0.5ml (lot 650453/079P), in the right deltoid. Concomitant therapy that day included a dose of hepatitis A virus vaccine (unspecified) (+) hepatitis B virus vaccine (unspecified) (lot AHABB28AB), in the left deltoid. Concomitant therapy included metoprolol succinate (Toprol XL tablets) and candesarten cilexetil (Atacand). Subsequently, by 12/10/2005 midday, the patient was having painful, red swelling in the arm and also had a fever. She gradually developed worsening symptoms with gradually increasing redness and swelling of the arm, higher fever, pain and burning in the arm and headache. She felt very ill and spent the entire day of 12/10/2005 in bed. 12/11/2005 the patient was seen in the doctors office. She continued to feel ill, She had a constant headache in the frontal area of the head which had not been helped by using acetaminophen (Tylenol). She had a fever up to 102. The temperature seemed to be constant, did not return to normal when she used medication. The arm was painful and becoming increasingly more tender. The patients temperature was 101.2F. There was enlarged, tender lymph nodes present in the right axilla but not in the right supraventricular area or the olecranon area. There was an area of bright red, hot induration measuring 5" in height x 8" in the horizontal plane. The assessment was cellulitis. The patient was treated with dicloxacillin 500 TID for the next 7 days, ice to the area if need be, cetirizine hydrochloride (Zyrtec) 10 mg 1 tablet daily and acetaminophen Tylenol 1000 mg every 6 hours and if necessary she could add ibuprofen 600, alternatively. She was to rest and drink plenty of fluids and return in 24 hours. On 12/12/2005 the patient returned to the doctors office feeling better. She was up at 400am with fever and took ibuprofen Advil at that time. She had been perspiring heavily through the night and alternating feeling very cold with feeling hot. The arm did not burn as much as it did before but the redness was a little bit larger. The headache was gone. She felt a little better generally. Her temperature was 98.3F, and 45 minutes alter it was 99.2F. There was still substantial swelling and tenderness in the right axilla. The area of induration had increased from 5" x 8" to 8" x 10" although it was a little softer and mottled at the edges. It was hot to touch. The patient again was assessed with cellulitic reaction to Pneumococcal 23v polysaccharide vaccine. The patient was to continue with dicloxacillin, rest, and acetaminophen Tylenol and ibuprofen Advil as needed. The patient recovered on 12/28/2005. It was noted that the patient had never had a serious reaction to a shot. The reporter considered the patients experience to be disabling and an other important medical event (OMIC). Additional information is not expected.