Age: 28.0
Sex: F
Vaccine: RAB
Symptoms: Acne, Chest discomfort, Dyspnoea, Headache, Injection site joint pain
Clinical narrative: Pt. sts. had a red & white pimples rash around face/neck and down the chest - 23d after receiving vaccines - rabies-RABAVERT - pt went to ER. See attached -details. 8-31-11 Pt. was bitten by kitten on thumb. Kitten died and was buried. 9-01-11 pt's thumb condition declined. Pt went to Emergency Room. A bite report was filed. Pt. sent home with azithromycin and doxycycline rx. 9-02-11 Health Department went to pt home. The momma cat and the rest of the kittens were dying of unknown reasons. Pt immediately went to the Emergency Room (ER) at medical center. Pt received RIG and rabies vaccine. 9-03-11 Pt c/o extreme right shoulder pain with intense headache. 9-04-11 Pt developed nausea with the continuation of 9-3-11 symptoms. 9-05-11 Pt returned to ER for health department administration of 2nd RABAVERT. 9-6-11 Pt c/o increased headache with very little use of right arm due to extreme pain with any movement. 9-7-11. Pt c/o continued previous symptoms with facial itchy red rash with some "pus pimples" and spread to chest...began BENADRYL 50 mg 2x day. 9-08-11 Pt c/o increased headache and arm pain unbearable. Pt returned to medical center ER. PT received IV drip DELTASON and BENADRYL. Rash and itchiness diminished by 75% and arm pain was gone upon discharge. Pt given prednisone 50 mg/day x 4 days rx with BENADRYL 50 mg 3 x day. 9-09-11 Pt to health department received 3rd RABAVERT vaccine. Pt did not state any problems. No signs or symptoms noted. 9-10-11 Rash gone. Pt continuing prescribed medication. 9-11-11 Rash still gone with minor headache. 9-12-11 Rash still gone. 9-13-11 Pt began itching behind ears, rash worse than previous and on face neck and chest. Pt increased BENADRYL to 75 mg/3x day. 9-14-11 Pt rash improved slightly and developed SOB. 9-15-11 Rash improved further with SOB increased. 9-16-11 In the am pt developed chest congestion, nausea and vomiting "foam". Headache redeveloped and rash still visible and itchy. Pt came in to receive 4th RABAVERT vaccine. Upon asking pt if any problems with the vaccine had occurred...pt stated that she wasn't sure. After continuing to question pt. Pt  stated that she developed a red and white itchy/pimply rash that started around the hair line and came up to the eyebrows and around the face and around the back of the neck and down the chest about 2-3 days after receiving the vaccine. Pt went to ER and received prednisone rx and BENADRYL of which she was finished with and was continuing to take "75 mg" of BENADRYL to help with the itching. Pt appears short of breath and observed mild rash on face and neck down towards chest. Pt assessed. Dr declined to administer 4th rabies vaccine at the health department. Pt went to medical center ER for 14th day rabies vaccination. Pt received IV push steroid and BENADRYL. Pt waited one hour and was then given the rabies vaccine. Pt sent home with prednisone 60mg/x5days and BENADRYL. Pt developed SOB and tightening in chest within one hour of being released home. 9-17-11 Pt c/o slight arm discomfort with headache and tight chest. Pt still taking medications. 9-18-11 Pt c/o arm movement more restricted due to pain and SOB hasn't improved. Pt still taking medications. 9-19-11  TC to pt. Pt sts no rash or headache. and SOB improving. Pt still taking medications. 9-20-11 Pt SOB extremely improved. Started to itch late evening with no rash. Pt still taking medications. 9-21-11 TC to pt - pt c/o itchy with no rash, Still wheezing. Pt last day of medications. 9-22-11 RC to pt. Pt sts no rash and SOB much better. Notified patient RN requests patient to have a rabies titer test between 28-35 day after rabies vaccine started and may need 5th dose of rabies at ER. Pt sts will call if any problems and verbalized understanding. 9-30-11 TC to pt. PT sts rash never developed. Pt has had no SOB x 5 days. Pt still itching behind ears and on neck. Pt given instructions to return to clinic for rabies titer on 10-3-11 at 9 am. Appt made for pt. Ordered obtained from RN. Pt verbalized understanding. 10-3-11 Pt no show for rabies titer. 10-4-11 TC to pt. Pt counseled on importance of blood test. Pt verbalized will come right in. Pt here for rabies titer. 10-12-11 Pt titer returned low -.26 needs to be >.49. 10-13-11 TC to pt. Pt given counseling pt needs 5th dose of rabies vaccine. Titer low. Pt to RTC in am and p/u rx and records to take to medical center ER 10-14-11. Pt verbalized understanding. 10-14-11 Pt here. Pt given IMOVAX rx, BMC records, rabies titer lab results. Pt going to medical center ER now. 10-17-11 TC to pt. Pt sts went to medical center ER 10-15-11. Pt. sts received IV drip ZANTAC, IV push BENADRYL and a steroid. Pt sts waited 15 min. and received IMOVAX LDT IM. Pt sts no rxs given upon discharge from ER. Pt sts as of today has had no reaction...no SOB or rash which usually presents on the 3rd day. Pt given counseling to check rabies titer. Appt for pt made for 10-28-11 at 8:30 am. Pt verbalized understanding of importance of titer level to be checked. Pt to call medical center of any symptoms occur. 10-28-11 Pt, here. Rabies titer drawn. Pt sts having no SOB or rash. 11-09-11 TC to pt. Pt given 1.94 rabies titer results and counseled no need for more rabies vaccine. Pt verbalized understanding. Pt sts no signs of SOB or rash. 11-15-11. Pt closed to VAERS reporting.