That evening large area on leg red and hot, runny nose. Continue to worsen. Lethargic, fever 102.2. Dr office didn't want to see pt per mom saying all normal reaction. *Note: Findings attached. On 03/07/05 after waiting 2 hours to see MD, Pt was lethargic with temp of 102.5. Per mom MD didn't want to see her, has RN from office call mom  to look at injection site. Mom states was told she was "over reacting". Mom states  wants to see MD, MD wanted to give pt antibiotic injection but mom refused, she gave pt a blood test. She gave her a nebulizer treatment and albuterol for it. She agreed she was very ill. Though disagreed it was from the vaccine. That night Pt woke up kicking and jerking her arms screaming make it stop, holding her head over and over. That continued every night until she had medication given from a different MD on 03/07/2005. History of present illness: Pt 4 yrs old, received DT, Hep B, and polio vaccine last week. Previously 08/10/2004 she received DT, IPV, Hib, MMR, and Hep B. The week before the vaccine, she was very healthy. The evening after the vaccine she had a red, hot and swollen area where 1 of the vaccines were given.(not sure which vaccine, the nurse did not document this). That night she started with a clear runny nose and a persistatnt bronchial cough. The next day she started with fever around 102.0 degrees Fahrenheit. By the 3rd day, she was listless, no energy. She called the doctor's office and the answering service refused to contact the pediatrician. The next day she was still lethargic with 102 degree Fahrenheit fever, bronchial symptoms, told she had and ear infection and was prescribed an antibiotic, (OMNICEF) as well as albuterol suspension.  She was acting angry, staring off, aggressive 2 nights ago and each night since then waking up screaming "stop it" over and over for the last 3 nights and has been taking thuja. She now has a know where the swelling was today her energy has started to return. She is allergic to sulfites. Examination: Constitutional: The physical examination reveals: The head is normocephalic and atraumatic with normal hair distribution and no lesions present. Pupils equally reactive to light. Extra ocular movements intact. Nose and throat normal. Tympanic membranes normal, with some clear light fluid present. The abdomen is soft, nondistended, non tender, bowel sounds are present, no organomegaly. No masses. The exteremties show no clubbing, cyanosis, or edema. The lungs are clear to auscultation bilateral with no wheezes, rales, or rhonchi. The Heart exam reveals regular rate and rhythm(S1/S2), no murmurs. 1cm hard nodule right anterior upper thigh. 4mm general redness. Diagnosis: Poisoning by mixing bacterial vaccines, except combinations with a pertussis component. Plans: with this reaction we will no longer give her DT, polio, or Hep B vaccine. Next year this time we should get a measles IgG titer to see if she is immune or in need of the 2nd Measles. Only 1 mumps and reubella are needed and she has received this already. I see no evidence of a bacterial infection and I would not give the antibiotic. There are a few things we can do for the vaccine reaction: Give her 4 capsules of Vitamin A, once tonight, twice tomorrow and once Saturday then stop. Give her 1/2 tsp of liquid zinc 3x a day, try getting 2 doses in today. Do this for 1 week. Give her 1/4 tsp of buffered vitamin C 3x Q D for the next week. Give her 1 tsp of larix 3x Q D for the next week. In the future on first signs of illness, do this regimen but only 2 capsules per dose of Vitamin A because there was mercury in the vaccine she received, give her 1/4 tsp twice a day of lipocuetical glutathione twice a day until the bottle runs out.