Age: 61.0
Sex: F
Vaccine: HEP
Symptoms: Feeling hot, Injection site pain, Pruritus, Rash erythematous, Rash macular
Clinical narrative: I received the third hepatitis B vaccine on 4/11/18. On 4/13 while at work, I suddenly developed red, blotchy spots on my right hand and wrist. The spots have spread over the past month to both hands, arm, legs, my hands and feet are very itchy. Symptoms not better so saw a doctor on May 17th. Completed a MEDROL dose pack over the next 6 days. The red spots are most notable on right hand (biggest). Smaller spots to back of wrists, outer and inner thighs, fronts of ankles and legs, and arms. Palms of hands and bottom of feet continue to be very itchy. I feel very hot at times. I have informed my nurse manager and employee health at the hospital where I work. I started November 27, 2017. I am moving to another area. The spots have not gotten better. The vaccine site was sore for couple days. Notes with employee health: 05/30/2018 Patient came to employee health to discuss a potential reaction to her 3rd hepatitis B vaccine that was administered on 04/11/2018 to her right deltoid. Patient explained her twin brother died with neurological symptoms in 2009 after he received a flu vaccine, so she wanted to make sure she reported her Hepatitis B in case it is related. This was her 3rd Hepatitis b vaccine, and the 2nd Hepatitis B vaccine had the same lot number and expiration date. Hepatitis B #1 and #2 she had no symptoms. Onset of her symptoms was on 04/13/2018 two days later. Patient was at work on 04/13/2018 when symptoms started. Her symptoms small area on right hand between her thumb and pointer finger. VAERS reported, but symptoms do not match the onset of symptoms to the CDC Hep B vaccine. CDC Hepatitis B states "Allergic reaction is very rare, estimated about 1 in a million doses, and would happen within a few minutes to a few hours after vaccination. Her symptoms do not match to be an allergic reaction to Hepatitis B vaccine. Patient is allergic to many things, such as mold, dust, chicken feathers, erythromycin, PCN, KEFLEX and was tested by dermatologist when she was a child. Patient does not have access to this report, but feels there could be other allergies listed. She saw her primary who did not know why she has these symptoms but is treating her with steroids. We discussed potentially other causes of her symptoms. We discussed contact dermatitis. We discussed work and home products that could have caused the onset of these symptoms. We discussed common allergies like rubber and nickel that are found both in work and home environments. Work environment: - Patient wears gloves when cleaning purple top and chlorine bleach wipes - Patient uses Nitrile gloves, powder free and no latex gloves - Isolation gowns she does put gloves over the gown. - Patient does not handle chemo Home environment: -Carpet was pulled up at home and replaced Feb. - Furniture cleaned about the time symptoms started. Denies gardening - She does not know if she has changed any lotions/chemicals/laundry detergent at home. Patient has 6 cats in her home. Patient has used the alcohol foam which switched December 2017. Patient has only worked at Medical Center since November 2017. At this time her symptoms are systemic all over her body. Her primary care told her to call if the first round of steroids has not resolved it and she would order her a second dose of Prednisone. Patient stated she was going to call her today. Plan: - Complete her second round of Prednisone per her physician.