Age: 3.0
Sex: F
Vaccine: FLU(H1N1)
Symptoms: Pallor, Unresponsive to stimuli, Vomiting
Clinical narrative: Approximately 2 to 3 minutes after my daughter received her vaccine (which was around 11 a.m. I don't know the exact time), after we had put on our coats preparing to leave I noticed my daughter was looking pale and swaying back and forth.  I immediately took my daughter back to the nurse who gave the injection and told her my daughter was reacting to the vaccine.  The nurse initially offered grape juice, thinking this was a drop in blood glucose.  My daughter refused to drink something and was looking worse, she was very, very pale and began coughing along with (what sounded like to me) stridor.  I asked the nurse what she had available for an allergic reaction which she stated, "Benadryl."  I was becoming very concerned that Benadryl was not going to be sufficient to counteract what was taking place and stated this to the nurse.  I had oral liquid Benadryl with me in my purse, I decided to give my daughter one teaspoon of Benadryl while the nurse seemed to be figuring out what was going on or what to do.  After administering the Benadryl to my daughter I immediately picked her up in my arms, she was extremely weak and still very pale but not unconscious.  I started following the nurse, who was now looking for an EMS person or physician, with my daughter and I began calling out for a physician or someone to help.  I asked several times for someone to please get some epinephrine and administer it to my daughter.  As I was directed to the EMS person the physician on duty came over to assess my daughter.  For a brief moment my daughter was stood up on her feet again and she immediately vomited.  I then sat down in a chair with my daughter in a supine position; she was limp and only occasionally opened her eyes to sound; she did not verbally respond when prompted.  The doctor was trying to assess her and I was asking for epinephrine, which a second nurse (not the nurse who did the injection) brought over.  After determining the appropriate dose for my daughters weight she was given .15 mg of epinephrine (based on 35 pound weight), intramuscularly in her left thigh adjacent to the spot where the vaccine had been administered.  Within about 30 seconds to 1 minute of receiving the epinephrine my daughters lips started to pink up.  The nurse was trying to get a blood pressure reading but was unable to hear through her stethoscope with the noise level in the area we were in; she attempted more than one time to get the blood pressure but neither time was successful.  Both the nurse and I tried getting pulses from brachial and radial sites, which the nurse was able to finally get a brachial pulse of which I do not know the numerical value.  The doctor asked me to move my daughter over to the bleacher area for further assessment.  As a note, the fire department and EMS showed up within about 10 to 12 minutes of the initial onset of the reaction.  EMS then administered oxygen via a non-rebreather mask and did an assessment of my daughter.  No IV's were placed, no fluid replacement was given by EMS.  I then carried my daughter over to the EMS gurney and she and I were transported together to the emergency department of the hospital. By the time we were placed in the EMS truck (where my daughter received a second assessment from a paramedic) for transport to the hospital my daughter's color was returning but she was still pale, she was conscious and responding to some questions.  At the hospital the nurse assessed my daughters oxygen saturation, which was 99% on room air with a heart rate of 106 and a temperature of 37.4 degrees Celsius.  The emergency room physician came in and did an assessment.  The MD stated that my daughters lymph nodes were swollen. My daughter remained in the emergency department (ED) for observation for 4 hours.  By the second hour of being in the ED my daughter was interactive and able to drink juice.  When we left the hospital we were given a prescription for an EpiPenJr. of .15 mg; prednisone 15 mg once daily and told to give her around the clock Benadryl.  The diagnosis was anaphylaxis.  10/27/09 ED records received service date 10/24/09. Assessment: Anaphylactic reaction. 2 minutes post-vaccination became pale, limp, retractions and inspiratory stridor. Vomiting. Benadryl and epinephrine administered by parent (RN) with resolution of symptoms. Now asymptomatic. Discharged to home.