Age: 40.0
Sex: F
Vaccine: RAB, RAB
Symptoms: Tenderness
Clinical narrative: Initial non-serious case received from a health care professional on 17 September 2008.  A 40-year-old female patient received the first three doses of IMOVAX (all three have lot number B0182-2; route/sites not reported) and a dose of IMOGRAM (lot number D0053-3, route/site not reported) following exposure to a bat.  IMOGAM and the first IMOVAX dose were given on 03 September 2008.  Additional doses of IMOVAX were given on 05 September 2008 and 10 September 2008.  The patient had no known bite, but a bat had been found in her room.  On an unspecified date, the patient was diagnosed with dependent edema of the left leg.  No clubbing, cyanosis or deformity were noted and the patient had full range-of-motion.  There was no dependent edema of the ankle and foot.  The patient was evaluated at a health center.  At the time of the report, patient outcome was 'not recovered'.  Follow-up information was received 09 October 2008 form a health care professional.  The patient was evaluated by their physician on 17 September 2008.  Pre-existing medical conditions included a sulfa allergy and a history of high blood pressure.  Vital signs included a temperature 97.1 degrees Fahrenheit (oral), pulse 72, respiration 14, and an initial blood pressure reading of 162/100, followed by a subsequent reading of 150/110.  The patient had not been taking any concomitant medications.  Clinic notes indicated the patient had a history of high blood pressure which had been controlled lately without medication; however she had been treated for high blood in the past.  The patient had previously received IMOGAM and three prior doses of IMOVAX Rabies vaccine for post exposure prophylaxis which were reported to have been administered in the thighs and upper arms (specific routes/sites by product were not reported).  The patient had been due to receive her fourth dose of IMOVAX Rabies vaccine that day.  According to the medical records history of present illness, the patient had experienced additional symptoms of fatigue, a general achy feeling, and mildly sore joints (onset dates not reported).  The patient noticed dependent edema, LLE/ankle and foot two nights ago (also reported as "X's 1 week").  The swelling worsened as the day progressed and her foot throbbed when in the dependent position.  At the time of evaluation, the patient had no current swelling.  Physical examination revealed lungs, heart, pulses, skin and psychological were normal; extremities were noted as "no clubbing, cyanosis, edema, or deformity noted with normal full range of motion of all joints.  No dependent edema or erythema noted of feet.  No ankle edema.  Neg.  Homans's sign LLE."  The patient was diagnosed with 1). Adverse Drug Reaction, Late Effect and 2).  Dependent Edema, Left Leg.  The patient was instructed to return for a recheck in 14 days if not significantly improved, or sooner if symptoms worsened.  The patient was also instructed to confer with the health department as to the safety of completion of the rabies vaccine series in view of apparent systemic adverse reactions.  At the time of the report, the patient had not recovered from the event.  Follow-up information was received 17 November 2008 from a physician who examined the patient on 17 September 2008, three weeks after bat exposure.  The patient reported experiencing dependent edema of the left lower extremity on 15 September 2008.  When examined two days later, there was no edema.  The patient complained generally about fatigue, achiness and mild joint soreness.  The physician reported there were no specific start or stop dates for these symptoms and that they seemed to correlate with the time period when the patient was receiving rabies vaccine (the previous three weeks).  On the date of exam, the patient's elevated blood pressure readings were evident.  The patient had a history of hypertension and was not on medication.  The patient reported that her blood pressure had been controlled without medication lately.  The physician did not know if the blood pressure elevation was related to the rabies vaccine.  The patient was not treated for her symptoms at that time.  The patient was seen by the reporting physician after 17 September 2008 and has been treated for hypertension.  The patient was referred back to the county health department for advice regarding completion of the rabies series.  The physician stated, "I am not aware of any long-term effects of the rabies vaccine."  Follow-up was received from a health care professional on 08 December 2008.  The first IMOVAX dose was given intramuscularly to the left leg and IMOGRAM was given intramuscularly to the left arm.  The second and third doses of IMOVAX were given intramuscularly to the left arm.  The fourth and fifth doses of IMOVAX (lot number for both doses was B0182) were administered intramuscularly to the left arm on unspecified dates and the patient had no further reactions following those doses.  Follow-up information was received from the reporter on 22 December 2008.  The patient received her fourth dose of IMOVAX on 19 September 2008, and her fifth dose on 02 October 2008.  Documents held by sender:  Medical records