Age: 69.0
Sex: F
Vaccine: FLU4, FLU4
Symptoms: Anxiety, Conjunctival hyperaemia, Erythema, Flushing, Heart rate increased
Clinical narrative: I wanted to report that I probably had a slightly delayed systemic allergic reaction to the high dose quadrivalent vaccine. On 10/2/23 at 9:30 AM, I received Fluzone HD flu vaccine manufactured by Sanofi given by the pharmacist at Pharmacy; there was slight bleeding at the injection site immediately after, which I attributed to my increasing muscle mass there with weight training. There was the usual mild soreness at the injection site afterwards. At about 3 PM on 10/3/23, I noticed that my medial left arm was sore; I pulled up my sleeve and saw my medial arm was swollen and dark pink with what looked like a large local reaction. There was no swelling over the injection site. I thought perhaps some of the vaccine had tracked down over my biceps and I was having a large local reaction there; I did take pictures of the reaction. I put ice on that and tried to elevate my arm. However, by a little after 4 PM, my face started getting very flushed and my conjunctivae were getting red, and I noticed my pulse was faster than usual at 100. I felt a little funny in the head, not really dizzy like my blood pressure was low but like I had some anxiety brought on by adrenaline from the reaction, and I felt my left hand might be a little tingly as if the nerves to my hand were getting pressed by the arm swelling. My blood pressure felt normal when I checked my pulse although I didn't take my BP; and I tried to take my temp, but my electronic thermometer battery was low and my mercury thermometer broke in two when I pulled it out of its enclosure. I didn't feel short of breath and I didn't have hives or joint pain. Because Pharmacy where I got the shot is two blocks from my home, I went over there to be sure they had not accidentally given me another Tdap as I had that vaccine there in mid-August and to get my BP taken. They said it was documented that I got flu vaccine. They could see my face and conjunctivae were beet red, so one of the two pharmacists there did take down the information to report this reaction along with the lot number UY8072BA to VAERS as I clearly was having a reaction to something, probably the flu vaccine. My O2 sat there was 100% but apparently a BP cuff wasn't easily available. I bought diphenhydramine and took 25 mg at 5 PM. Within an hour, my pulse was back to normal at about 80 and my facial and conjunctival redness were gone. My arm swelling was still there of course although the arm was less sore. I did take another Benadryl 25 mg in the middle of the night, and by the next morning, the arm swelling was better but not gone, and I felt back to normal.  I know this was a somewhat delayed reaction to the vaccine but I wonder if this is because I'm on amitriptyline chronically which has antihistaminic properties. I was really surprised, almost shocked, at how quickly I got worse. About an hour after noticing the sore red arm, my face got beet red with flushing and my heart rate rapidly went up probably from histamine release of mast cell activation. I think the reaction might have gotten a lot worse if I hadn't taken diphenhydramine so quickly, two hours after the onset of first symptoms. And I was very surprised at how quickly the flushing of my face and conjunctivae and my tachycardia resolved, within an hour of taking diphenhydramine.  Besides my chronic conditions of interstitial cystitis, glaucoma, chronic back pain, hyperlipidemia and glucose intolerance, I actually have been feeling healthier and more energetic than usual this last month. I haven't had any acute illnesses recently; I did get the Tdap vaccine on 8/18/23, six weeks before this vaccine.  I wonder if I've gotten allergic to the flu antigens because I've had flu vaccines every year since I was in my early 30?s, and perhaps also because for the last four years I've been getting the high dose vaccine made for older adults, even though some think my biologic age is younger than my chronologic age of almost 70.   I'm not sure I should take any more flu vaccines, and now I'm a little wary of taking other vaccines without having rapid access to Epi-Pen and diphenhydramine.  The pharmacist seemed to think I could still take the lower dose vaccine in the future, but I'm hesitant, so I will be talking to my physician and maybe the CDC or FDA about that.  I know this was reported by the pharmacist on 10/3/23 but she didn't know the follow-up after diphenhydramine, and I know the system does combine reports of the same event so I know this won't be counted twice.