Received May 29, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| PNC20 | PNEUMO (PREVNAR20) | PFIZER\WYETH | UNK | — | IM / LL |
| PNC20 | PNEUMO (PREVNAR20) | PFIZER\WYETH | 3 | LN4931 | IM / LL |
Patient was previously active and ambulating without any difficulties. He was admitted to hospital for evaluation for re-listing for cardiac transplantation and PICC line placement from 5/5-5/8/2025. PCV20 vaccine was administered IM in the left thigh on the evening of 5/7/2025. The next morning when patient woke up he was complaining of significant left leg/thigh pain and refusing to bear weight due to pain. There was no obvious erythema or swelling noted at that time. He has continued to complain of left thigh pain and refused to bear weight on that leg since that time. At home (5/8- 5/14) patient required use of a wheelchair or had to be carried. He was readmitted to hospital on 5/14 for management of cardiac failure symptoms. During this hospitalization he has continued to experience pain in the left thigh area and was noted to have tenderness to palpation and swelling of the thigh for which the work-up below was conducted. Swelling improved with application of a compression wrap. In the past 24-48 hours he has begun putting some weight on the left leg but still experiences discomfort. An evaluation was completed to rule out other conditions on the differential diagnosis e.g. hematoma/bleed, pyomyositis/bacterial infection, DVT, fracture etc which were negative.
Admitted to hospital 5/5-5/8/2025 for evaluation for cardiac transplant re-listing due to significant coronary artery vasculopathy and heart failure.
Patient has Noonan syndrome with severe hypertrophic cardiomyopathy s/p cardiac transplant in infancy in 2017 complicated by 2 episodes of presumed cellular medicated rejection in the early transplant period. His past history is also notable for recurrent C. difficile associated diarrhea for which he underwent fecal microbiota transplants x2 in 2022. He also has a history of neutropenia (likely drug induced) and recurrent fevers, now resolved since approximately 2020. He is on chronic growth hormone.
Aspirin, carvedilol, everolimus, tacrolimus, ferrous sulfate, furosemide, guanfacine, levocarnitine, acetaminophen
None
Ultrasound left knee (5/25/2025) - no knee joint effusion. Ultrasound left thigh (5/26/2025) - subcutaneous edema of the left groin and thigh without an organized fluid collection or hematoma. x-ray of left femur (5/27/2025) - no fracture.