Age: 53.0
Sex: F
Vaccine: HEP
Symptoms: Headache, Hypertension, Laboratory test abnormal, Nausea, Pain
Clinical narrative: This case was reported by a consumer and described the occurrence of hypertension in a 53 year old female who was vaccinated with hepatitis B vaccine recombinant for prophylaxis. A physician or other health care professional has not verified this report. The patient reported that she had no relevant medical history, concurrent conditions, or concurrent medications. On 3/12/03, the patient reportedly received the first dose of Engerix B. In March 2003, post-immunization, the patient experienced hypertension with blood pressure to a maximum of 180/100 mmHg. The patient was seen by a physician. The Engerix B immunization series was discontinued. As of 6/20/03, the hypertension persisted. The blood pressure of 180/100 mmHg in this report is considered medically serious (OMIC). Comment: the lot number provided, ENG5353B, is not a complete lot number. The follow up received on 8/15/03 states blood pressure in the physician's office was 150/108mmHg. The pt reported that the chest pain did not worsen on inspiration. The physician noted "Mild pain to deep palpation in the anterior aspect of the left trapezius but no obvious pain to compression of the body of th etrapezius." Results of an electrocardiogram and chest x-ray were "unremarkable." The physician made diagnosis of "1. Chest pain. 2. Elevated BP." He noted, "headache likely caused from BP elevation." He prescribed candesaartan (Atascand) 16mg daily. He ordered blood analyses and recommended that the pt undergo stress echocardiography. The blood analyses revealed "mildly" elevated glucose concentration and elevated triglycaride concentration; "otherwise, blood work was compeltely NL." The pt returned to her physician on 4/28/03. She reported that she no longer experienced headache. The pt reported that she had discontinued candesartan therapy because "it caused her to feel nauseated, sick to her stomach with headache." The pt reported that she had been seen by a chiropractor on 4/9/03, "who put her on a vitamin compolex because he said that her liver was damaged." This is in spite of hepatitis panel drawn by me which shows the pt has never had hepatitis A, B or C. She is hepatitis B surface antibody positive; however, this would stand to reason since pt did undergo hepatitis B number one shot." The pt reported that her blood pressure "dropped" after beginning therapy with the "vitamin complex." The pt reported that she "was told by her chiropractor that it would take 12 weeks for the effects of this med to be permanent." Blood pressure on 4/28/03 was 156/98mmHg. The most recent info was received from the pt's physician on 8/15/03. He indicated that the hypertension persisted as of 7/29/03. He considered the hypertension to be serious because it jeopardized the pt or required intervention. He indicated that the hypertension was possibly related to Engerix B administration, or to "concurrent illness." The Engerix B immunization series was discontinued.  Follow up on 09/30/2003: "The most recent information was received from the patient on 09/11/2003.  The patient forwarded a letter that she had written to another party on 05/20/2003.  In the letter, she stated, "For the first 12 hours after the shot I felt OK. The next morning I was feverish, throwing up, sweaty" and had "a terrific headache.  That lasted for about 48 hours.  symptoms dissappated [sic] except for the headache.  That got progressively worse along with a feeling like a toothache under my left ear, going down my neck to my chest.  Because it was not going away I went to my medical doctor on 03/18/2003."  She also wrote that on 04/09/2003, "I had blacked out long enough to fall.  BP in [the chiropractor's] office was 180/100."  Receipts from the chiropractor indicated that he had prescribed "Calsol", Cataplex E", "Cardiotrophin FMG", "Hepatrophin FMG", "Betacal", and "Immunoplex".  The patient wrote that, as of 05/20/2003, her blood pressure was 149/83 mmHg.  She also wrote, "I still have discomfort in the neck and chest area."  However, information provided by her primary physician indicated that the patient did not report chest pain on 03/31/2003 or 04/28/2003.  She also wrote that she had not missed any work because of these events.  Comment: The lot number provided by the patient, ENG5353B, is not a complete lot number."