Received Oct 29, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | 7+ | NA0589 | IM / LA |
| FLU3 | INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) | SANOFI PASTEUR | 5 | U8837CA | IM / LA |
Patient received flu and COVID vaccination on 9/16/25 and soon developed bruising on both arms and left leg. She presented to an ED on 9/29/25 in which they noted "Ecchymosis noted to bilateral upper extremities, no palpable cephalohematoma or fluctuance. Ecchymosis noted to entirety of left lower extremity, various stages of healing." Her hemoglobin was 7.7 after previously being in the 11's but no coagulation test was sent. She had an ultrasound of left leg which was negative and so she was discharged with outpatient follow up. The patient then saw her PCP on 10/3/25 who again noted significant bruising "Diffuse areas of ecchymosis most notable of left LE, and of b/l UE" (including photos) and repeated her labs and found her hgb to be at 6.5 so sent her to the ED on 10/4/25. There she had coag testing which showed normal PT of 11 but aPTT of 72, Factor VIII level of <1 and a mixing study showing incomplete correction with mixing and prolongation of aPTT after 1hr of incubation consistent with an inhibitor. Inhibitor testing was positive for a FVIII inhibitor with a Bethesda Unit of 33. The patient was started on porcine FVIII initially with transition to emicizumab once a FVIII inhibitor was identified. She was also started on prednisone 1mg/kg and rituximab 375mg/m2 x4 weekly doses. She was discharged after 12 days on 10/17 and has remained outpatient on a prednisone taper with completion of weekly rituximab treatments. Repeat coag studies have been normal but repeat FVIII testing is pending.
n/a
HTN, HLD, glaucoma, generalized weakness, osteoarthritis, CKD stage IIIa, vitamin D deficiency, anemia
? acetaminophen (Tylenol) 500 mg tablet 2 tablets, Every 8 hours PRN ? albuterol 90 mcg/actuation inhaler 2 puffs, inhalation, Every 4 hours PRN ? calcium-vitamin D3-vitamin K (Viactiv) 650 mg-12.5 mcg-40 mcg chewable tablet 2 tablets, oral
cipro - rash