Age: 32.0
Sex: F
Vaccine: FLUX, FLUX, FLUX, FLUX
Symptoms: Injection site erythema, Injection site irritation
Clinical narrative: This RN returned and contacted office to discuss reactions to intramuscular influenza vaccines. She advised first influenza vaccines was given in 1999. Her medical records documents split influenza given 7 Nov 1999 (unknown manuf/lot#). She recalls getting a large red bump to her arm about size of an orange that extended up to her shoulder that lasted about 3-5 days. She recalls same thing occurring in 2000 (no vaccine documented) with addition of hives extending to her face/neck and upper chest region (above bra line), had sniffles, her throat itched, and her right eye was swollen. She recalls self-treating and doesn't recall any ER/medical visits as worked with medical teams. She did not receive another flu vaccine for the next several years. Her medical records list other split influenza with unknown manufacturer and lot number given on 17 March 2004, Oct 2006 (MedImmune 500433P), 25 Nov 2009 (H1N1), and 25 Sep 2010, and she reports progressive site irritation (small erythematous area at site that would progress each year). On 21 Sep 2011 patient requested flu vaccine given due to increased risk of exposure as a health care provider. The MD pretreated her with oral ZYRTEC and ZANTAC given possibility of allergy to vaccine component prior to administration of IM Influenza preservative free (per 21 Sep 2011 note). She recalls "3-4 hours later while napping (got sleepy from "BENADRYL") she heard strange noises only to realize she was wheezing, tachycardic, had increased congestion, hives and eyes swollen". She notified nursing staff in medical. This note documented bilateral bronchial wheezing with no accessory muscle use otherwise normal physical exam (no vital signs found) and treated with Albuterol MDI with resolution of symptoms. She again went to sleep and felt better upon awakening. Since then she has not had IM influenza. She reported a "similar" adverse reaction during a prolonged dental procedure (root canal) on 2 April 2012 (date per medical records). Providers document 30 minutes after injected with lidocaine with epi she began to experience shaking in arms, face and jaw, heart racing and felt lightheaded (no note in dental records on this event). She never lost consciousness, but had to fix her gaze on one spot for senses to return. She reported total of 2 episodes, one on the ship and one in the clinic during a period of 1 week following multiple palatal injections. Records document on 16 April 2012 and 16 May 2012, she was evaluated by allergist for possible allergy to lidocaine with/without preservative. Allergy testing to lidocaine with and without preservatives was tolerated well with no adverse reactions. Providers note documents latex IgG titer sent on 18 April 2012; however no results were found. Vaccine history: Records list FLUMIST was given 22 Nov 2008, 28 Aug 2009, 28 Aug 2012, 09 Oct 2013, 22 Oct 2014, and 01 Oct 2015 (records list both mist and IM given). She concurrently received other vaccines from 2000-2015 to include MEN, MMR, Typhoid, Td/Tdap, YF, and AVA without adverse reactions. Allergist note 18 Apr 2012 lists possible hepatitis B non-responder with negative varicella IgG, and positive MMR titers from 2009.