November 13, 2010. The patient is a 15-month-old female who received her MMR vaccine yesterday, presenting now with fever and increasing redness in her left thigh. Fever started last evening. No cough. No nausea, vomiting, fevers, or chills. She has not been eating particularly well, but is eating when I walked into the room. Otherwise, she has been doing well without complaints. This is a 15-month-old female presenting for evaluation of fever and increasing thigh erythema since her immunizations yesterday. I believe that either the mild fever or discomfort that she is having is an unexpected response to following immunization. I am however concerned with the area of erythema in her left medial thigh. I would expect a small amount of erythema from the injections and however this is an approximate 4 to 5 cm circular area that is exquisitely tender to the touch. It is warm. It does make me concern that there is a mild cellulitis that is associated with her recent injection. Nothing to suggest abscess. Nothing to suggest necrotizing fascitis. The patient is otherwise well appearing. I believe at this point it is likely beneficial to start her on KEFLEX therapy and have her followup with her PCP. I also instructed mother to utilize MOTRIN or TYLENOL for discomfort and ice to the area. The patient was otherwise well appearing and will be discharged to home in good condition. 11/15/2010 The patient is a pleasant 15-month-old female who presented to my office acutely added on for left thigh cellulitis. She was seen in my on November 12, 2010 for 15-month well-child check. At that time, she was MMR, PREVNAR and VARIVAX. She was given MMR and PREVNAR in the left leg, MMR in the upper leg, and PREVNAR in the lower portion of the quadriceps muscles. The patient was somewhat fusilladed that evening and then developed significant fever with a temperature of 101.8, and worsening redness, pain, and swelling at the left thigh. Because of this, they took the patient to the Emergency Department where they were seen by ER physician and placed on KEFLEX therapy. Of note, the mother states that during the immunization, she thinks that the needle that was used may have actually pierced her skin prior to the injection while she was holding the patient down for the shots. The patient has never had any other reactions to immunizations in the past. Mother states now she thinks she has a yeast infection because of the KEFLEX she was given as she is frequently asking to be changed, and crying and holding her vaginal area. She will finish the KEFLEX as directed and we will give her DIFLUCAN 40 mg/mL. She will take 1-1/2 mL by mouth daily x1 dose and may repeat tomorrow if still having symptoms. Certainly, she will get possible reoccurrence of this because of her being on antibiotics. I did speak with our office manager regarding the above event and this will be handled appropriately. November 20, 2010. This is a 15-month-old, who presents to the emergency department November 20, 2010 at 12:50 a.m. Mother reports that the child had an immunization last Friday. She got an infection in the left leg from that and was on KEFLEX from Saturday to Thursday but then she started getting symptoms of a yeast infection, placed on DIFLUCAN, and those symptoms improved, but then she was seen in the primary care office, diagnosed as an otitis media and placed on AUGMENTIN. She has had a dose of that today and the KEFLEX was stopped. She began to have fever of 102.9 tonight. She has not taken the AUGMENTIN. She is crying and is difficult to console. The patient was given fever instruction sheet. She is to use MOTRIN or TYLENOL for fever or pain, take all of the antibiotics which will be AUGMENTIN, return for worsening problems or concerns, and follow up with doctor if not improved in the next 24 to 48 hours, otherwise next week for reevaluation. The parents state understanding. The child was discharged improved. 11-22-10 I spoke with patient's mother when she was here with patient regarding further information I needed to complete this form. When asked if pt had ever experienced any adverse effects from previous vaccines she stated that pt usually always gets all the symptoms on the sheet of paper (VIS) we give her. I asked if pt had ever needed medical treatment following previous vaccines and/or has she ever called our office following previous vaccines, regarding side effects, and she stated "no".