Received Jan 7, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| PNC15 | PNEUMO (VAXNEUVANCE) | MERCK & CO. INC. | 1 | Z009264 | IM / RL |
Child is seen today for hospital follow-up after a PICU admission from 12/19?12/20/25. She initially presented to an outside hospital with tachycardia to the 220s and was transferred to [withheld] PICU due to elevated troponin levels. This occurred within 24 hours of receiving the Prevnar vaccine, with concern for transient myocardial inflammation. During hospitalization, troponin levels were trended and normalized prior to discharge. Echocardiogram demonstrated excellent biventricular function with a small incidental PFO. He remained hemodynamically stable, on room air, and well appearing throughout admission. Since discharge, mom reports significant clinical improvement, including heart rate within normal limits, consistent wet diapers, and overall good appearance. No recurrent tachycardia or respiratory distress noted. The feeding plan includes continued thickened, fortified feeds, with an outpatient swallow study scheduled for 1/14/25. Child has had recent weight loss, which she feels is likely related to recent hospitalization and associated illness, as well as ongoing diarrhea symptoms that began after vaccination 1. Tachycardia Recent PICU admission (12/19?12/20/25) for tachycardia to the 220s with troponin elevation, concerning for transient myocardial inflammation within 24 hours of pneumococcal vaccination. At present, per parent report, patient is clinically improved, eating well, and without recurrent tachycardia. - Will hold off on further vaccinations at this time given recent PICU admission for tachycardia and troponin elevation temporally associated with vaccination. - Will reassess immunization plan after completion of cardiology follow-up and further guidance from specialists. - Outpatient Pediatric Cardiology follow-up in 1 month as scheduled and will repeat EKG per inpatient recommendation - Anticipatory guidance has been provided. - Follow up sooner as needed for any concerns. - Continue thickened, fortified feeds as recommended - Maintain scheduled swallow study on 1/14/25 - Monitor closely for recurrence of tachycardia, poor feeding, lethargy, color change, or respiratory distress 12/19-20/25 [withheld] admission - Presented to outside hospital for tachycardia to 220s and transferred to [withheld] PICU for elevated trop levels. - Admitted to PICU w/ evidence of myocaridal inflammation and a troponin leak w/in 24 hours of vaccination w/Prevnar. - Trop trended and normal the day of discharge. - ECho shows a small PFO w/ excellent function in both ventricles. - CXR: Improved aeration of the lungs. Increasing mild hazy central atelectasis/edema/infiltrates. - Repeat EKG suggests hypokalmeia. - Remained on RA, hemodynamically stable and well appearing on exam. - SLP and dietician consulted. - Observed feed w/ SLP notable for 2 ABD events that resolved w/ stimulation. - Recommendations: continue thickened, fortified feeds w/ scheduled fup swallow stdy on 1/14/25. - VS notable for hypertemsion after receiving NS bolus at [withheld] Hospital and briefly started on mIVF upon admission. - Recommend fup BP w. PCP. - Fup PCP 1-2 days and outpt Cardio in 1 month. R00.0: Tachycardia, unspecified 2. Adverse effect of vaccine, subsequent encounter Tachycardia and troponin elevation occurring within 24 hours of Prevnar vaccination
Hip US
famotidine 40 mg/5 mL (8 mg/mL) oral suspension GIVE 0.25 ML(S) BY MOUTH TWICE A DAY (DISCARD AFTER 30 DAYS).