Age: 59.0
Sex: F
Vaccine: HEP, HEPAB
Symptoms: Confusional state, Fatigue, Feeling abnormal, Inappropriate schedule of product administration, Influenza like illness
Clinical narrative: Nausea; Felt like she had the flu; Achiness; Fatigue; Wrong vaccine administered; Inappropriate schedule of vaccine; confused; felt bad; This case was reported by a pharmacist via call center representative and described the occurrence of feeling bad in a 59-year-old female patient who received HAB (Twinrix) (batch number H4A37, expiry date 18th October 2021) for prophylaxis.   Co-suspect products included HBV (Engerix B adult) (batch number 9T25S, expiry date 3rd April 2020) for prophylaxis.   The patient's past medical history included feeling unwell, tiredness and pruritus. Previously administered products included Zyrtec (received dose of 10 to 20mg) and Allegra (received dose of 180 to 240mg). Concurrent medical conditions included chronic idiopathic urticaria.   On 10th June 2019, the patient received the 1st dose of Twinrix. On 19th July 2019, the patient received the 2nd dose of Engerix B adult. On 10th June 2019, less than an hour after receiving Twinrix and not applicable after receiving Engerix B adult, the patient experienced feeling bad. In July 2019, the patient experienced confusion. On 19th July 2019, the patient experienced wrong vaccine administered and inappropriate schedule of vaccine administered. On an unknown date, the patient experienced nausea, influenza like illness, pain and fatigue. In June 2019, the outcome of the feeling bad was recovered/resolved. On an unknown date, the outcome of the nausea, influenza like illness, pain, fatigue, confusion, wrong vaccine administered and inappropriate schedule of vaccine administered were unknown.   It was unknown if the reporter considered the feeling bad, nausea, influenza like illness, pain and fatigue to be related to Twinrix. It was unknown if the reporter considered the confusion to be related to Engerix B adult.  Additional case details were reported as follows: The patient was not feeling well, complaining of tired and itching, which she had a history of.  The patient advised to come back in a few days, which she did and only received Engerix as her second dose of Twinrix series, which led to wrong vaccine administered and inappropriate schedule of vaccine administered. The patient was planning a trip to and also had to get a yellow fever vaccine, so she saw in a other location, which was where the group was located that she was traveling with. The physician informed patient that she now needed to receive an adolescent dose of Havrix because she needs that vaccine due to the fact that she didn't get it for the second dose of Twinrix, as only Engerix B was given. With the first dose of Twinrix, within in 1 hour of the shot, patient felt bad for 36 hours.  Less than a 2 months after vaccination, the patient had nausea, felt like she had the flu, achiness, and fatigue. The Twinrx (Hepatitis A/Hepatitis B combo shot), patient received the combo Hepatitis A/Hepatitis B first dose in June at her local neighborhood Pharmacy.  The pharmacist administering the shot told her to return in 1 month for 2nd dose and then 6 months for 3rd. When she returned, different pharmacist (the lead pharmacist at this location) told her that she didn't really need the Hepatitis B at all (that it was optional) and that she just needed 2nd Twinrx at 6 months. She said they never give the 2nd shot as Twinrx at one month in a 3 shot sequence - just Hepatitis B.  She then recommended the Hepatitis B shot which she returned to same pharmacy a few days later to get. On the day of reporting, patient was told by a doctor who specializes in that she would not have lifetime immunity on this schedule but this could be remedied if she receive an adolescent dose of hepatitis A. Less than a month, after vaccination the patient was so confused and do not know what should to do. The reporter informed patient she should now receive an adolescent dose of Havrix because she only got Engerix for the 2nd dose. The reporter called back later in the day (after previously reporting adverse event) and reported the patient wants to continue dosing with Twinrix, not monovalent vaccines. The patient's next dose of Twinrix would be late. The patient would also end up having an extra dose of Engerix-B. The reporter consented to follow up. This is 1 of the 3 linked cases reported for same patient by the same reporter.