Age: 36.0
Sex: F
Vaccine: SMALL
Symptoms: Nausea, Obstructive airways disorder
Clinical narrative: Seen 6/10/07 at ER for c/o difficulty breathing. Had smallpox vaccination on 6/8/07. SM reports that she  had nausea first day of vaccination and then the next day developed chest tightness and difficulty breathing. Was given Prednisone, X-Ray performed and showed partial closure of airway. Monitored for two hours and released. Was seen on 6/11/07  with c/o difficulty breathing again. Reports that she took Benadryl at 1500 and 2200 the previous day. Prednisone continued and Benadryl was ordered. Pulse Ox was 99% on room air. Returned  at 1030 same day with continued sx and was given Epipen. Seen on 6/12/07 and reports no further difficulty in breathing but has had dizziness present today as well as low back pain. Discussed sx and need for follow up should they continue. Had taken Benadryl earlier in day. 07/09/2007 Request for link to 281414. Date of vax verified with vax provider as 6/8/2007.  07/09/2007 MR received including one ER visit of 6/10/2007 and subsequent outpt F/U. Pt arrived by ambulance with c/o tightness in the throat and concern over breathing ability. PE WNL.  BP 145/93. Txd with Prednisone and D/c. Impression:  Throat tightness.  Recent Small Pox vaccine. F/U for allergic rxn to small pox-angioedema.  Still c/o choking sensation on 6/11/07. Had c/o palpitations and elevated BP the day before.  Primary DX: Angioedema. Anaphylactoid Drug Reaction. 07/10/2007 Info rec'd from pt/reporter.  MRs requested. MR received from PCP for OV 7/6/2007 describing initial anaphylaxis rxn to smallpox vaccine, still taking multiple allergy meds and prednisone. Now c/o chest pain and tachycardia. Exam WNL.  To perform echo to evaluate cardiac (scheduled 7/10/07 per pt).  MR received from Allergist for visit 7/5/07 with c/o SOB, CP, fatigue, palpitations, dizziness, night sweats and HTN beginning June 10,2007. DX: Ideopathic Anaphylaxis/(?) Edema vs Samllpox vaccination Rx. 07/17/2007 MR received for o/n admission 6/15-16/2007 for c/o 6 episodes of difficulty breathing with with the sensation of throat swelling since having smallpox vax on 6/9/2007. Pt c/o dizziness and H/A with some double vision.  PE WNL. Primary DX:  Respiratory distress. Follow-up: Seen 6/10 @ ER for thickness in throat and difficulty breathing. 6/12 seen at ER same symptoms. 6/13 Seen @ER same symptoms. 6/14 seen @ ER admission overnight. Seen 6/18, 6/20 for followup with military doctors. 6/26 seen with acute chest pain, shortness of breath, fatigue, palpitations, dizziness and high blood pressure, EKG showed tachycardia. 6/27 given case manager r/e med hold vs refrad. LOD being worked. 6/29 medical refrad to home of record without income or health benefits in middle of being symptomatic daily. 7/2 seen at ER for all symptoms stated above. 7/5 seen by local Allergist, prescribed new meds, ordered numerous labs, Chest xrays and EKG. EKG abnormalities present in left ventricle and left atria, sent EKG to cardiologist for interpretation. 7/6 appt with primary physician Dr concerned about possible myocarditis &Ordered echocardiogram. Reviewed all tests requested by allergist& will get copies. Cardiologist, Allergist and family doctor are now handling this case. It may take a few more weeks to recover due to cardiac involvement. Also uncertain if I will be able to manage this outpatient basis or require hospitalization again. 02/02/2010 Patient sent to hospital for prolonged anaphylactic life or et development of sinus tachycardia and CP.