Age: 29.0
Sex: F
Vaccine: FLUN3
Symptoms: Pruritus, Rash maculo-papular, Red blood cell sedimentation rate increased, Throat tightness, Urticaria
Clinical narrative: This 29 year old patient received Nasal FluMist on Friday, 16 September 2005.  She awoke three days later unable to bend or move with pain and swelling to bilateral hands, fingers and back of her knees.  She reported welts covering her torso and extremities. She denied any fevers, chest pain, or breathing problems.  She was taken to Emergency Room 19 Sept 2005 5:33 am and treated with IV Solumedrol and Benadryl for an "allergic reaction". She was released home with prednisone 50 mg PO x 4 days, Benadryl 50 mg PO every six hours as needed and Pepcid 20 mg one tablet twice a day for ten days. She reported some resolution of swelling/hives while using the Benadryl; however the hives returned with any cessation of her medication.  She followed up on 20 Sept 2005 9:00am advising her that her swelling had decreased with above medications however the itching persisted. Dr. noted macules and papules over the extremities and trunk with erythema and pruritus present.  Hydrocort Val (Westcort) topical 0.2% ointment was added to her above medications. This service member returned to work beginning to complain of "feeling bad" meaning fatigued, malaise, joint pain and "felt a lump in her throat".  That evening she slept fitfully awakening early Wednesday morning wheezing, short of breath with tightness in her throat, and hives/welts all over her body.  She returned to Hospital 21 Sept 2005 and advised again it was an allergic reaction.  She was treated with another dose of Benadryl, Pepcid and IV Solumedrol She was instructed to continue home use of above medications. She followed up 22 Sept 2005 still with itchy rash/welts and joint pain/swelling for 4 days. This patieny stated there was a large purple bruise to palms of both hands, medial aspect both knees, which was swollen and tender to touch. There was no known trauma or recent illness. The physician noted reddish maculopapular pruritic rash/wheals over her arms, legs, back, chest, palms. She was diagnosed with dermatitis due to drugs and medicine (FluMist) and myalgia/myositis. Zyrtec and Darvocet were prescribed with prednisone increased to 60 mg x 3-4 days, and continued use of Benadryl prn, Motrin and Pepcid.  She was referred to the Vaccine Healthcare Center 28 Sept 2005 with concerns of a possible adverse event to the FluMist vaccine.  This patient continued to complain of severe (9-10/10) diffuse bilateral joint pain, persistent hives/rash to her torso and extremities and difficulty sleeping at night due to the pain. She reported no further "bruising" to her hands but stated swelling to her hands was worse every morning. The rash was described as multiple fine pale pink single macular pruritic rashes seen mainly in the morning to bilateral inner elbows, knees, back, and axilla. She still complains of "a constant lump" just "under her cricothyroid membrane" in her throat "as if trying to swallow but can't get it to go down".  She denies any difficulty breathing, talking or swallowing. Laboratory studies include high CRP at 55.8 (normal 0-8) with a borderline positive ANA at 1:80 speckled.  Her rheumatoid factor was negative, CK was 22 and normal CBC, Chemistry, and urinalysis. As of 01 November 2005 she reported completion of prednisone. She continues to get "controllable rashes" and variable joint pain. She continues to follow up with her PCP for repeat labs and specialty referrals.