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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Evaluate adult immunization records and identify missing recommended vaccinations based on patient's age, comorbid conditions, risk factors, and time since previous vaccinations

  • Recognize appropriate contraindications and precautions for administration of immunizations in adult patients

  • Develop an appropriate plan for vaccine catch-up including an evaluation of which vaccines can be administered at the same time

  • Describe appropriate patient education for potential benefits and adverse reactions of vaccines

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PATIENT PRESENTATION

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Chief Complaint

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"I was told to see my physician after being discharged from the local hospital. I was admitted to the hospital for 4 days because I broke my arm after a bad car accident."

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History of Present Illness

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Eric Jones is a 23-year-old college student who was a restrained driver in a MVA 7 days ago on December 2, 2012. He was not ejected from the car and had no loss of consciousness. In the ED, he was found to have a left mid-shaft humerus fracture and spleen laceration. He was taken emergently to the operating room and a splenectomy was performed due to uncontrollable bleeding. The rest of his hospital stay was uneventful but he was told to see his primary care physician (PCP) after discharge for follow-up and to make an appointment with an orthopedic specialist for his humerus fracture. During his initial visit to his PCP, his physician asks the clinic's pharmacist to review his immunization history.

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Past Medical History

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Migraines diagnosed 5 years ago

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  • Left humerus fracture 7 days ago

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Past Surgical History

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Splenectomy 7 days ago

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Family History

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Mother and father are both alive. Father is 52 and has a history of T2DM. Mother is 48 and has no significant past medical history. He has no siblings.

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Social History

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Patient is currently a third year college student (psychology major) and lives off-campus in an apartment with his girlfriend and 2 other roommates. He has two healthy indoor-only cats. He denies smoking and IV drug use. He drinks alcohol socially (3–4 beers per week).

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications (Current—No Medications Prior to Car Accident)

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Acetaminophen 650 mg PO q 4 h PRN musculoskeletal pain

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Docusate 100 mg PO q 12 h

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Famotidine 20 mg PO q 12 h

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Oxycodone (oral solution) 5–10 mg PO q 4 h PRN pain

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Immunizations

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Most recent photocopy from 06/20/2011 of immunization record in patient's medical chart at clinic:

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IMMUNIZATION RECORD
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Name: Eric P. Jones
Birthdate: 2/8/1989

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