Age: 63.0
Sex: F
Vaccine: RAB
Symptoms: Pruritus, Thyroid disorder
Clinical narrative: A 63 year old female patient experienced left arm pain below the injection site, muscle and joint aches, shortness of breath, itching all over, leg weakness, left cheek numbness, diarrhea, strange dreams like hallucinations, food cravings, thyroid fibrillation, swollen eyes with right eye oozing, and stomach aching while being treated with RabAvert for post-exposure prophylaxis after questionable exposure to a bat.  She received her first dose of RabAvert on 07/28/2004, the second dose on 07/31/2004 and the third dose on 08/04/2004.  Her medical history was significant for recurring urinary tract infections, fungal infections, and acute bronchitis.  Concomitant medications included Tiazac, Metoprolol, steroid nasal spray, Ibuprofen, Augmentin and Pao d'Arco herbal medication. On 07/28/2004 after the first dose of RabAvert, the patient experienced her left arm hurting below the injection site.  She also became short of breath which started right away and became intermittent.  She was also experiencing itching all over.  Everything that had been bothering her for years seemed worse since taking the vaccine.  She had left cheek numbness and leg weakness like after a car accident, thyroid fibrillation, strange dreams like hallucinations, food cravings, some stomach aching probably from eating too much, and diarrhea.  On 08/04/2004 she reported that most of the events had resolved by the end of the day that had begun or the next day.  The diarrhea wasn't really diarrhea but frequent formed stools. The food cravings and stomach pain resolved.  The leg weakness was 90% resolved.  The muscle and joint aches were not as severe and the changes in consciousness with strange dreams like hallucinations were more like ordinary dreams.  The right eye oozing was reported when she received her 08/04/2004 dose of RabAvert but no treatment was prescribed.  She had itching at the injection site with the third dose. Follow up information received on 08/06/2004:  After the third dose of RabAvert, the patient noted changes in a mole on her breast during showering.  The mole reportedly curled up in the darkened sections while wet but returned to being flat after drying.  She also reported pain in her abdomen in the same place where she used to have pain when she was diagnosed with endometrosis. Follow up information received on 08/16/2004:  The patient experienced a sharp nerve like pinch repeatedly in her left arm and a bump on the right arm next to the injection site following the 4th dose of RabAvert on 08/11/2004.  She also reported a continuation of her weird dreams.  Two days after the report the pinched nerve feeling was reported to occur only after using the arm.  It does not occur when the arm is at rest.  The abdominal pain and change in mole were reported as resolved.  The bump had disappeared and left only a red spot which had also resolved.  Her weird dreams were more normal.  The lot number for the RabAvert injections was reported. Follow up information received on 08/25/2004:  The patient reported headaches lasting from 12 to 23 hours.  The headaches reportedly started as an uncomfortable feeling during the RabAvert injection series and became worse on 08/04/2004 after injection number three.  On 08/23/2004 she was hit on the head with a macaroni box and felt tat the RabAvert injections aggravated the headache.  She went to the urgent care center and was placed on over the counter corticosteroid nasal spray, amoxicillin, antihistamines and Zyrtec.  On 10/06/2004 she had a rabies antibody level test done.  The results were pending at the time of this report. Follow up information received on 11/02/2004:  The patients titer levels were reported as greater than 1:5 indicating an immune response. Follow up information received on 12/13/2004:  The date of the rabies titer was corrected to 10/06/2004.  The results were greater than 1:50.