Age: 41.0
Sex: F
Vaccine: FLU4, PPV, TD
Symptoms: Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
Clinical narrative: Wednesday, August 22, 2018 9:30AM Receive pneumococcal polysaccharide vaccine in left arm Took 400 mg ADVIL before appointment. Also had an influenza vaccine in the left arm, but higher toward shoulder (no reaction). Had a tetanus shot in right arm (no reaction). 10:30AM Itching and discomfort at injection site, which had swollen to about half the upper arm with swelling that was visible from under a dress. 2PM Increased swelling, heat and itchiness at injection site. Took 400 mg ADVIL. 5:30 PM Overall feeling of malaise and pain at injection site, along with swelling and heat. 6:45PM - Midnight Fever of 102.3, extreme pain at injection site that ice packs don't ease,  uncontrollable shaking and feeling freezing despite fever. Took 400 mg ADVIL. Took 50 mg BENADRYL. Thursday, August 23, 2018 Approximately 2AM sweating, extreme arm pain, fever down to 101.5. Took 400 mg ADVIL. Continued icing arm. Approximately 4AM Vomited for the first time. Approximately 10AM Called Dr.'s office with symptoms. 10AM-6PM Fever ranging from 99.5 - 101.8, sweating, nausea, vomiting, thirst (couldn't keep down water), extreme arm pain at injection site. 7PM Drew first line around swollen/red portion of injection site with purple marker. Friday, August 24, 2018 8AM Called Dr.'s office for an appointment, no doctors available so went to Urgent Care. Approximately 9:30AM Received Rx. Of Cephalexin, took double dose immediately at doctor's direction. Doctor said to go to ER Saturday morning if symptoms hadn't improved or worsened. All Day Red, swollen portion of injection site continued spreading, emanating heat, hard, very tender and stiff. Took 400 mg ADVIL. Took 50 mg BENADRYL. Took Cephalexin. 7PM Drew second line around swollen/red portion of injection site with red marker. Took Cephalexin. Saturday, August 25, 2018 12:30AM Went to Emergency Department. White blood count 14.8 (high). C-Reactive Protein 129 (extremely high). Electrolytes- good. Approximately 1:30AM        Received first IV antibiotic (kind unknown). Approximately 2AM. Received IV Vancomycin. Approximately 2:50AM Extreme itchiness of scalp, shoulders back and chest. Skin turned reddish and felt very hot/burning. Approximately 2:55AM Treated for Red Man Syndrome with IV BENADRYL. Approximately 4AM Admitted into room. 2nd set of Labs show White Blood Count of 13.1. Calcium 8.2. Electrolytes - good. Items of note during hospital stay: Saturday afternoon received another dose of Vancomycin, spread over two hours instead of one. Received preventive BENADRYL orally. Still experienced Red Man Syndrome symptoms, but not as severe. Due to swollen, painful injection site arm and IV in the other arm, sleep was elusive. In 48 hours had 2.5 hours of sleep. Due to the lack of sleep a 2-day migraine set in. Received two doses of IMITREX, which provided some relief. Saturday afternoon labs showed labs are normal. WBC of 7. One doctor in the emergency department said he wasn't able to tell if I was experiencing cellulitis or a severe reaction to the vaccine, but they are treating for the cellulitis. All doctors at hospital said they'd never heard of a vaccine leading to cellulitis. Discharged Sunday, August 26 at approximately 12PM.