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Found 963 cases where Symptom is Idiopathic t hrombocytopenic purpura or Thrombocytopenia or Th rombocytopenic purpura and Vaccination Date on/after '2006-06-01'

Case Details

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VAERS ID: 344232 (history)  
Form: Version 1.0  
Age: 1.22  
Gender: Male  
Location: Hawaii  
Vaccinated:2009-03-26
Onset:2009-04-10
   Days after vaccination:15
Submitted: 2009-04-15
   Days after onset:5
Entered: 2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1250X / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1006X / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Blood product transfusion, Contusion, Gingival bleeding, Petechiae, Platelet count decreased, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gingival disorders (narrow), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI
Preexisting Conditions: None PMH: evaluation 3 mo prior for macrocephaly WNL.
Allergies:
Diagnostic Lab Data: Platelet count, 3000 LABS: Head CT WNL. Final plt ct 26K(L).
CDC Split Type:

Write-up: Petechial rash + bruising + oral bleeding 4/10. 4/11 ER - transferred to hospital. IVIG + Prednisone for thrombocytopenic purpura. 4/21 Link w/344276. 4/21/09 Received hospital medical records of 4/12-4/14/2009. FINAL DX: immune thrombocytopenia purpura; recent viral infection Records reveal patient experienced rash all over that increased to blotching & bruising. Seen in ER where plt count 3K & pt transferred to higher level of care. Sick family member w/flu-like symptoms. Pt had clear rhinorrhea x 1 wk & was teething. Heme/Onc consult done. Tx w/IVIG x 2. steroids. Improved & d/c to home on tapering steroids w/PCP f/u. Follow-up - Continue''s blood test so far so good. Visit with hematologist -stable.


VAERS ID: 344941 (history)  
Form: Version 1.0  
Age:   
Gender: Male  
Location: Unknown  
Vaccinated:2009-02-26
Onset:0000-00-00
Submitted: 2009-04-23
Entered: 2009-04-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / UNK UN / ID
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Military       Purchased by: Unknown
Symptoms: Contusion, Epistaxis, Hypersensitivity, Idiopathic thrombocytopenic purpura, Mouth haemorrhage
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200901658

Write-up: Initial report was received on 21 April 2009 by another manufacturer that received the report from a healthcare professional on 13 April 2009. A male service member (age not reported) was vaccinated with ACAM2000, SP Biologics, lot number VV04-003A) on 26 February 2009. Approximately one month later, after his deployment, he developed bleeding and bruising from the nose and mouth. While traveling, he received Yellow Fever vaccine (manufacturer and lot number unknown) and Mefloquine (malaria prophylaxis). He was deployed to a foreign country where he was diagnosed with idiopathic thrombocytopenia purpura (ITP). The report also states an allergic reaction occurred in February 2009. No additional information was provided. Documents held by sender: None


VAERS ID: 345190 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2009-04-16
Onset:2009-04-23
   Days after vaccination:7
Submitted: 2009-04-28
   Days after onset:5
Entered: 2009-04-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / UNK UN / ID
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER B0347 / UNK UN / IM

Administered by: Military       Purchased by: Military
Symptoms: Idiopathic thrombocytopenic purpura, Lymphadenopathy, Petechiae, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None; NKDA. 7/14/09 Hospital records received DOS 4/27/09 to 7/8/09. Recurrent staph skin infections, gluteal abscess. Acute severe headaches. Smoker.
Allergies:
Diagnostic Lab Data: Platelet counts: 4/26/09: 1K; 4/27/09: 16K; 4/28/09: 34K. 7/14/09 Hospital records received DOS 4/27/09 to 7/8/09. LABS and DIAGNOSTICS: Platelets Blood 1 x10(3)/mcl (L). CBC - WBC 13.5 x10(3)mcL (H) Neutrophils 11.6 x10(3)/mcL (H) Neutrophils 85.5% (H) Lymphocytes 9.1% (L)Platelets Large - Moderate. Bilirubin 1.5 mg/dL (H).
CDC Split Type:

Write-up: Inpatient consult has been requested on a 20 y/o patient hospitalized for severe thrombocytopenia and ITP in association with the receipt of vaccines. Symptoms: Petechiae, Lymphadenopathy, axillary. 7/14/09 Hospital records received DOS 4/27/09 to 7/8/09. Assessment: Thrombocytopenia NOS. Idiopathic thrombocytopenic purpura. Patient presented with mild left axilla pain and axillary lump. Bruise right politeal fossa, followed by mottling bruise / rash on feet, ankles, legs. MUltiple petechiae on lower legs, ecchymotic bruises on calves. Vaccination site - large purplish hued leasion with a darkish scar/old blood central area left deltoid. IVIG administration. Dyspepsia. Headache ''behind eyes'', photophobia. ''Feeling terrible''. Not well hydrated, not active, uncomfortable, acutely ill.


VAERS ID: 345319 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Massachusetts  
Vaccinated:2009-03-04
Onset:2009-03-15
   Days after vaccination:11
Submitted: 2009-04-27
   Days after onset:43
Entered: 2009-04-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 3 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Evans syndrome, Irritability, Thrombocytopenia
SMQs:, Haemolytic disorders (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None Family hx: Parent w/ulcerative colitis, migraines
Allergies:
Diagnostic Lab Data: Multiple including thrombocytopenia LABS 3/15/09: initial plts 5K. Coombs (+) LABS 4/10/09: Plts <5K, US of abdomen r/o IS. CT head WNL. Stool (+) rotavirus.
CDC Split Type:

Write-up: Came down with Evans Syndrome 3/15/09. Seen for irritability 3/7/09. 5/4/09 Received hospital medical records of multiple admits. FINAL DX: thrombocytopenia; Evans syndrome Clinic visit 3/7/09 for crying & tugging at ears. Noted to have dime size bruise at injection site right thigh. Ears were clear & dx w/pain/irritability s/p immunizations. RTC 3/15 w/easy bruising x 1 wk worse last 2 days all over body. Referred to ER for coagulopathy. 3/15-3/21/09 Admit Records reveal patient experienced bruising x 1 wk. Admitted for Heme & tx w/IV high dose steroids which failed to increase plts. Tx w/IVIG & improved. D/C to home on continued steroids w/central line for future IVIG tx. D/C to home on steroid taper. 4/3-4/4 Admit for IVIG. Plts 35K. 4/6 Seen in clinic for URI & left OM. Tx w/oral antibiotics 4/7-4/8 Admit for IVIG. Plts 21K. 4/10-4/17 Admit for vomiting, increased bruising, irritability, blood tinged stool & falling plt ct. Tx w/IVIG 4/22 Clinic visit for resolved OM. 4/26 Seen in ER for episode of irritability.


VAERS ID: 345764 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Male  
Location: Unknown  
Vaccinated:2008-03-11
Onset:2008-06-10
   Days after vaccination:91
Submitted: 2009-04-22
   Days after onset:316
Entered: 2009-05-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Biopsy bone marrow, Blood product transfusion, Colonoscopy, Ecchymosis, Full blood count abnormal, Idiopathic thrombocytopenic purpura, Platelet count decreased, Polyp
SMQs:, Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20 mg/day; Metoprolol, 50 mg/day; LIPITOR, 10mg/day; Finasteride, 5mg/day
Current Illness:
Preexisting Conditions: Pre-existing Hx Hypertension; Angioplasty with stent (DEC 1998 and FEB 2000) 6/24/09 Hematology/Oncology consult received DOS 6/12/08 to 4/16/09. Hypertension, hypercholesterolemia, coronary artery disease, BPH, hernia repair, psoriatric arthritis, Baker''s cyst, chronic kidney disease. Hep B surface antibody (+). Asthma with sulfa drugs.
Allergies:
Diagnostic Lab Data: CBC values for Platelets: DEC. 2007 - 242, 000 / uL; JUNE 10, 2008 - 34, 000 / uL; JUNE 12, 2008 - 37, 000 / uL; JUNE 16, 2008 - 45, 000; JUNE 17, 2008 - 37, 000; AUG 02, 2008 - 14, 000; AUG 02, 2008 - 17, 000; 9-18-08 - 55, 000; 9-25-08 - 138, 000; 10-2-08 - 105, 000; 10-29-08 - 113, 000; 11-26-08 - 104, 000; 2-18-09, 152, 000; 3-18-09, 203, 000; 4-22-09, 335, 000; See page 1/2; Related medical Hx list all labs in records and Private Internist. 6/24/09 Hematology/Oncology consult received DOS 6/12/08 to 4/16/09. LABS and DIAGNOSTICS: Bone marrow - Peripheral thrombocytopenia, Mixed hematopoiesis. CBC - Platelets 34000 x 109/L (L), occasional large platelets. PT 13.2 sec (H) PTT 25.1 sec (L) Fibrinogen 521 mg/dl (H). Renal Function 1.3 mg/dL (H). Liver Function - Total bilirubin 1.4 mg/dL (H). ER visit: X-Ray Chest - atelectasis. CT Abdomen - See medical records. Pancreatic enzymes elevated. Liver enzymes elevated. EKG - Abnormal record. Hep B surface antibody (+).
CDC Split Type:

Write-up: Early June 2008, noticed large ecchymoses on left flank. On June 10, a CBC showed platelets to be 36, 000 (normal 140, 000 -250,000). Saw hematologist at hospital. Test (incl. Bone marrow biopsy) Diagnosed ITP (Idiopathic thrombocytopenic purpura). Attempts to treat with WINRHO. High-dose Betamethasone and IG.G all failed. Started on study for N-Plate (AMGEN) platelets have now risen to 330, 000. Routine colonoscopy (3-24-08) with removal of 4 benign polyps (No complications). ZOSTAVAX administered 3-11-2008. Early June 2008 - 2 large ecchymoses of left flank . Subsequent Dx of ITP (see page 1/2) 6/24/09 Hematology/Oncology consult received DOS 6/12/08 to 4/16/09. Includes ER visit for 8/22/08. Assessment: Idiopathic thrombocytopenic purpura. Patient presented with concerns of increased bruisability. Later ER visit: Nausea and vomiting. Pancreatitis.


VAERS ID: 348920 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Florida  
Vaccinated:2009-05-18
Onset:2009-05-28
   Days after vaccination:10
Submitted: 2009-06-10
   Days after onset:13
Entered: 2009-06-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0315Y / 2 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Antinuclear antibody, Biopsy bone marrow, Blood product transfusion, Complement factor C3, Complement factor C4, Full blood count, Idiopathic thrombocytopenic purpura, Metabolic function test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness:
Preexisting Conditions: None 6/22/09-records received- PMH Depo Provera.
Allergies:
Diagnostic Lab Data: Unknown 6/22/09-records received-Two weeks prior platelet count of 26. Rheumatology labs negative.
CDC Split Type: WAES0906USA01158

Write-up: Information has been received from a physician concerning a 16-year-old female patient with no medical history who was vaccinated with the second dose of GARDASIL. Concomitant therapy included Depo-Provera. A week or two after the second dose of GARDASIL the patient developed idiopathic thrombocytopenic purpura and was admitted to hospital and given intravenous immune globulin (IVIG) 2 doses. The following lab diagnostics studies was performed: Complete blood count, Comprehensive Metabolic Panel, Antinuclear Antibody Test, serum complement C3/C4 ratio, Immunoglobulin A, Bone marrow biopsy. The patient has been discharged. The patient''s idiopathic thrombocytopenic purpura was considered to be disabling and an other important medical event. The patient had not been recovered. Additional information has been requested. 6/22/09-records received for DOS 5/28-5/30/09- DC DX: ITP status post 2 doses of IVIG with slight improvement of platelet count. Presented with newly diagnosed ITP with mild bruising. ICD-9 287.31.


VAERS ID: 349158 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2008-05-09
Onset:2008-05-09
   Days after vaccination:0
Submitted: 2009-06-12
   Days after onset:399
Entered: 2009-06-15
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Chlamydia identification test positive, Chlamydial infection, Drug exposure during pregnancy, Platelet count decreased, Thrombocytopenia, Ultrasound scan, Urine human chorionic gonadotropin positive
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: azithromycin; vitamins (unspecified)
Current Illness: Pregnancy NOS (LMP = 4/8/2008)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ultrasound, 08/22/208, screening; diagnostic laboratory, chlamydia positive X2; urine beta-human, positive; platelet count, thrombocytopenia
CDC Split Type: WAES0806USA08328

Write-up: Information has been received from a Nurse Practitioner, for the Pregnancy Registry for GARDASIL, concerning a 19 year old female with thrombocytopenia who on 09-MAY-2008 was vaccinated intramuscularly with a first dose of GARDASIL (lot # 659437/1266U). Concomitant therapy included tetanus toxoid, administered "on the same day, 09-MAY-2008") and vitamins (unspecified). On an unspecified date the patient had a positive urine pregnancy test. The patient''s LMP was reported as 08-APR-2008. The patient sought unspecified medical attention. Patient outcome was not reported. Follow up information has been received from a completed questionnaire by a certified nurse midwife (previously reported as nurse practitioner). It was reported on the questionnaire that the patient with no concurrent medical conditions, on an unspecified date experienced Chlamydia infection (2 episodes) and thrombocytopenia (previously reported as concurrent condition) during pregnancy (diagnostic tests performed on unspecified dates). Other medications used during this pregnancy included prenatal vitamins (unspecified) and azithromycin. On 22-AUG-2008, the patient had a screening ultrasound. On 10-JAN-2009 at 39 weeks from LMP, the patient delivered a male liveborn infant. He weighed 8 lbs and 03 oz, apgar score was 8/9. Additional information is not expected.


VAERS ID: 349692 (history)  
Form: Version 1.0  
Age: 1.25  
Gender: Female  
Location: New Jersey  
Vaccinated:2009-03-28
Onset:2009-04-08
   Days after vaccination:11
Submitted: 2009-06-22
   Days after onset:75
Entered: 2009-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1672X / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D33126 / 4 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Idiopathic thrombocytopenic purpura, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hospital records received DOS 4/8/09 to 4/9/09. Allergies to milk, peanuts, and eggs. Eczema. Tympanostomy, tubes placed. Adenoidectomy. Multiple ear infections.
Allergies:
Diagnostic Lab Data: CBC Platelet count 8,000. Hospital records received DOS 4/8/09 to 4/9/09. LABS and DIAGNOSTICS: CBC - Platelets 11/nL (L) Neutophils 22.6% (L) Lymphocytes 66.1% (H) Monocytes 3.5% (L) HGB 11.4 g/dL (L). CHEM - CO2 21 mmol/L (L) Albumin 3.3 g/dl (L) Calcium 8.0 mg/dl (L) LDH 335 U/L (H)
CDC Split Type:

Write-up: ITP treated with Win. 9/29/09. Hospital records received DOS 4/8/09 to 4/9/09. Assessment: Idiopathic Thrombocytopenic Purpura. Child presents with ''rash'' on stomach. cough. Petechia and bruising diffusely spread on body. Crying. ICD-9 Codes: 287.31 Immune Thrombocytic Purpura, 782.7 Spontaneous Ecchymosis.


VAERS ID: 349714 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: Vermont  
Vaccinated:2008-04-10
Onset:2008-05-20
   Days after vaccination:40
Submitted: 2009-06-15
   Days after onset:391
Entered: 2009-06-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB200BA / 2 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1309U / 1 UN / SC

Administered by: Private       Purchased by: Public
Symptoms: Contusion, Idiopathic thrombocytopenic purpura, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ITP; Bruises from Low Platelet count
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Plt count 26,000, low; decrease platelet count; still waxing and waning; She has chronic idiopathic thrombocytopenia but her baseline plt has improved
CDC Split Type:

Write-up: - Child received MMR and Hep A on 4-10-08, at age 2. - Mom noticed increase bruising 1 wk prior to office visit for the same. She was seen on 5-20-08 and Dxd to have Idiopathic Thrombocytopenia; Mom recently let me know that she believes this was a result of vaccination.


VAERS ID: 350022 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Male  
Location: Texas  
Vaccinated:2009-04-29
Onset:2009-05-11
   Days after vaccination:12
Submitted: 2009-06-24
   Days after onset:44
Entered: 2009-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER VV04003A / UNK UN / ID

Administered by: Military       Purchased by: Military
Symptoms: Anorexia, Arthralgia, Biopsy skin abnormal, Blister, Blood culture negative, Blood lactate dehydrogenase, Blood pressure increased, C-reactive protein increased, Cellulitis, Chest X-ray normal, Chills, Coagulation test normal, Culture urine negative, Culture wound negative, Dyspnoea, Exercise tolerance decreased, Fatigue, HIV test negative, Haematocrit decreased, Haemoglobin normal, Headache, Injection site erythema, Injection site pain, Injection site pustule, Injection site rash, Injection site scab, Injection site swelling, Joint effusion, Joint swelling, Joint warmth, Laboratory test normal, Leukopenia, Liver function test normal, Malaise, Mean cell volume normal, Normochromic normocytic anaemia, Oropharyngeal pain, Pancytopenia, Pharyngitis, Platelet count decreased, Polymerase chain reaction, Productive cough, Pyrexia, Rash pustular, Red blood cell sedimentation rate increased, Respiratory tract congestion, Reticulocyte count normal, Scab, Serum ferritin normal, Skin warm, Tenderness, Thrombocytopenia, Urine analysis normal, Vaccinia, Viral infection, Viral test positive, Virus culture negative, White blood cell count decreased
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Skin tumours of unspecified malignancy (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: pt reported "chest congestion" x 3 weeks antecedent to vaccination; was diagnosed with URI/pharyngitis at time of initial symptom onset
Preexisting Conditions: questionable history mild chronic leukopenia, thrombocytopenia, anemia with no known evidence immunodeficiency PMH: sensorineural hearing loss. Allergy: vancomycin. Family hx: bleeding disorder.
Allergies:
Diagnostic Lab Data: 5/13-15/2009: ESR 66-75 (high), CRP 10-12 (high), WBC 3000 range (low), Hct 31-32 (low), Plt 65-74 (low); normal chemistries, liver panel, LDH, ferritin, retic ct, coags, & urinalysis; negative wound/blood/urine cultures; negative skin viral cultures (vaccinia PCR not done); negative HIV; negative CXR; right knee x-ray indicated soft tissue swelling, no osteoarticular abnormalities; punch biopsy (right wrist) indicated DDX: hypersensitivity reaction, infection; some histologic resemblance to acute febrile neutrophilic dermatosis or other neutrophilic dermatoses; no evidence of vasculitis. 5/26/2009: WBC 3.7 (low), Hgb 12.1/ Hct 34.5 (low), Plt 99,000 (low); ESR 43 (high), ferritin 36, CRP 1.0. 6/11/2009: WBC 4.7, Hgb 12.8, Plt 89, MCV 89, normal diff; 6/24/2009: vaccinia PCR form viral isolate POSITIVE LABS: WBC 3,300(L), Hct 32(L), plts 55,000(L), ESR 75(H), CRP 12(H). CXR & UA WNL. X-ray right knee w/soft tissue swelling. Blood & wound c/s neg.
CDC Split Type:

Write-up: On 6/16/2009 center was notified by hospital of a vaccine adverse event following involving this patient. The event occurred in May 2009. Review of related notes as well as phone interview indicated this 34 y/o male, developed fever, chills, malaise, loss of appetite, headache, sore throat, productive cough & mild shortness of breath onset approximately 10 days following receipt of small pox vaccine (SPV) given on 4/29/2009. This was the only vaccine received that day; however, on 4/23/2009 he received anthrax vaccine (AVA) dose #1, Hep B dose #1, influenza (IM), & typhoid vaccines. SM was initially seen in hospital 5/11/2009 for URI-type symptoms & gave history of prior intermittent chest congestion for 3 weeks; he was diagnosed with pharyngitis & prescribed Z-PACK, ZYRTEC & MUCINEX-D. That night he felt worse, spiked temperature, noted pain with swelling at SPV site left deltoid; he was taken to local civilian ER, diagnosed with left arm cellulitis & prescribed SEPTRA & Clindamycin. At medical center follow-up 5/12/2009 he had temp 101.7, small tender pustule in right axilla & right knee pain/swelling; he was placed on quarters & asked to continue antibiotic therapy. By 5/13, he felt worse & had developed scattered pustular lesions over scalp, right hip, left leg, & had increased right knee pain/swelling. On 5/13 he was admitted to hospital with presumptive diagnoses: right knee cellulitis & disseminated vaccinia. Initial assessment by Infectious Disease (ID) on 5/14 indicated overall clinical improvement, but continued right knee swelling/warmth without tenderness; blanchable red rash at SPV injection site (stable pustule), & over right knee; multiple scattered tense blisters, not excluding palms & soles: vesicles in various stages, characterized as yellow on erythematous base, umbilicated or ruptured, some becoming pustular, some with honey-colored crusts; distributed over scalp, neck, shoulders, axillae, upper extremities, trunk, buttocks, lower extremities. SM was diagnosed with 1) mild-moderate generalized vaccinia with clinical improvement although with new lesions within past 36 hrs; 2) hydrarthrosis right knee/tib/fib without overlying lesions secondary to reactive vs. possible septic joint, 3) leukopenia consistent with systemic viral infection - questionable prior episode with severe strep throat but no evidence of immune compromise, 4) normocytic anemia with low MCV/wide RDW suggestive of iron deficiency vs. hemolytic anemia related to vaccinia, 5) thrombocytopenia possibly related to vaccinia, unable to confirm if preexisting; splenic sequestration or ITP considered. Treatment with VIG considered if symptoms worsened. SM continued on IV Clindamycin with close monitoring. He continued to improve clinically & was discharged a couple of days later. On 5/27, at his first outpatient follow-up post hospitalization, he was well, back to baseline except for slight reduced exercise capacity. The SPV left deltoid was scabbed; all other skin lesions were resolved without scarring (except over right wrist biopsy site); right knee symptoms resolved; vaccinia felt to be clinically resolved, but concern for possible mild immunodeficiency state that predisposed him to vaccinia (old CBC from 10/2007 indicated similarly low values for WBC, Hgb/Hct, & Plt counts). SM was referred to Hematology at hospital on 6/12/2009. By then, CBC showed WBC 4.7, Hgb 12.8, Plt 89, MCV 89, normal diff; diagnosis was pancytopenia - resolved & probably due to viral illness. He was advised to have monthly CBCs until normal or Plt ct at least $g100, Hgb $g13; If CBC did not return to normal or worsened, he should be re-evaluated by hematology. SM was cleared to deploy. 7/2/09 Received medical records. FINAL DX: generalized vaccinia from vaccination; cellulitis of right knee; hydrarthrosis right knee; leukopenia; anemia; thrombocytopenia; elevated CRP & ESR Records reveal patient experienced fever, chills, night sweats, HA, skin lesions, fatigue, right knee pain & redness. ID & Derm consult done after malaise, HA, fever x 3 days followed by scattered superficial pustules. Tx w/oral antibiotics w/minimal improvement. Admitted ICU 5/13 for IV antibiotics. Improved & d/c to home w/ID clinic f/u. Mostly resolved by clinic visit of 5/27. w/continuing decreased exercise tolerance & easy bruising. Referred to Heme.


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