Received Oct 20, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| DTAPIPV | DTAP + IPV (QUADRACEL) | SANOFI PASTEUR | 5 | U8209CB | IM / LA |
The patient received the DTaP (Quadracel) vaccine on 10/14/25 and developed symptoms within 12 to 24 hours. Initially, the parent thought the arm pain might have been due to sleeping position, but noted the arm was unusually hard and swollen. The redness was not fully circumferential but extended from the elbow to the shoulder, with the arm swelling to approximately double the size. The arm was red, tender, and warm, and symptoms worsened during the first 24 hours. The reaction persisted for about three days before resolving. There was no fever, weeping, or signs of infection, and no respiratory symptoms. The patient was evaluated at urgent care on the day of symptom onset, where no treatment was provided. DIAGNOSIS: Arthus Reaction = Type III Hypersensitivity Reaction: ASSESSMENT: Localized Arthus-type reaction following DTaP (Quadracel) immunization with onset within 12-24 hours, presenting as swelling, erythema, warmth, and tenderness from elbow to shoulder, resolved over 3 days without systemic symptoms; no evidence of infection or abscess. PLAN: - Documented Arthus reaction as a chronic issue in the chart for future reference. - Plan to delay next Tdap immunization until high school (approximately 10 years from last dose), unless earlier administration is indicated due to outbreak or tetanus-prone injury. - Advised that in the event of a tetanus-prone injury (e.g., stepping on a rusty nail) prior to next scheduled Tdap, may require earlier immunization or tetanus immunoglobulin; instructed parent to inform providers of this reaction if seeking care elsewhere. - Provided educational article regarding Arthus reaction and discussed expected course and future precautions.
Viral URI
History of speech delay - resolved.
Tylenol - for current cold
None
None