Age: 48.0
Sex: F
Vaccine: FLU4, TDAP
Symptoms: Blister, Blister rupture, Dermatitis contact, Pain
Clinical narrative: Patient came in on 10/4/21 regarding a potential adverse reaction to a flu and TDap vaccine. They were both given on the same day on 10/2 in the same arm. Patient requested to recieve both vaccines on the same arm. I advised the patient that she can get one on each arm since she seemed quite nervous about getting the vaccines. However, she said she was fine getting both vaccines in the same arm. She asked me if they interact with each other and I advised her that these two vaccines do not interact and that it is given often together. The patient came back on 10/4 to speak to the pharmacist on duty and was concerned because she had a small fluid filled blister off to side, same arm near the bandaid edge possibly (she already took the bandaids off) but it didn't look like it was at the actual injection area.  She usually has no problems with the flu vaccine the past years she had recieved it. After giving her the vaccines, the bandaid got stuck to my gloves and I reapplied it to make sure it stuck onto her arm properly. There was no redness, no swelling, or warmth at the area. She didn't report any other allergies, itching or fever and also said it wasn't spreading or getting worse. She said she had soreness which the pharmacist on duty told her was normal especially with aftering getting the TDap vaccine (she also said she's had the vaccine in the past in 2009 and just been due since its been over 10 years since she got it). The pharmacist on duty did leave a message to her doctor's phone number she provided just in case and she would follow up as well.  The pharmacist on duty gave the patient her opinion thought that it was most likely unrelated, if anything maybe a mild skin reaction, maybe due to the adhesive, but to keep an eye on it just in case.  It didn't look like a normal hive or cellulistis blister, not spreading no redness or fever. She had Claritin at home that she might use. The pharmacist on duty told her to use Benadryl for anything severe.  She would take Tylenol or ibuprofen if needed for the soreness. Patient states she does not have allergies to anything ( latex or medications).  I called on her 10/6 to follow up with her and to see how she was doing. She said she originally saw the blister on 10/5. She also told me she had a Clinic appointment on 10/5 and spoke to a nurse practitioner there. The nurse there told her it is possibly an allergic reaction to latex - no mention of being allergic to the actual vaccine itself. Nurse also told her the rubber stopper of the TDap vaccine we used is made out of latex. However, again, the blister did not form on the site of injection. It was formed on the posterior upper part of her left arm (closer to her armpit) where the edge of the adhesive part of the bandaid might have touched. Patient showed me a picture and the blister was not near the injection site. Patient also mentioned that she had used her own Band-Aid at home and she showed me a picture of the outline of the adhesive (showed some sort of slight reaction to the Band-Aid). The bandaid we had was a store off-brand.  She said she never had any problems with other bandages until now. She also informed me her blister ruptured the morning of 10/6. The nurse she spoke to told her to use gauze and tape to cover it up instead of a bandaid due to possibe allergic reaction to latex. Patient states she has a health appointment with a doctor on Monday, October 11th. I will follow up with her to see how the visit went and she will continue to monitor the area with the blister.