Age: 62.0
Sex: F
Vaccine: TDAP
Symptoms: Pain, Pruritus
Clinical narrative: Late note from 10/16/08 received a phone call from client stating she was having an allergic reaction from the Tdap vaccine that she received when the health department nurses came to medical center on 10/09/08 to vaccinate at risk staff with Tdap. (There had been 3 recently diagnosed cases of pertussis at least one of those cases was a one month old who was born at the hospital. Pt works in the nursery at hospital. Pt received her vaccine on 10/09/08 around 3:00 PM in her left deltoid. States developed swelling, redness, and fever at the vaccination site over the next 4 days. Stated the swelling and redness was no larger than a 50 cent piece. On 10/14/08 at approximately 8:00 am (upon rising), pt stated the swelling, redness and fever had grown to cover her arm from her shoulder above the injection site of approximately her elbow. Also she develop severe itching. Pt stated at that time she called employee health at hospital and was instructed to begin taking BENADRYL. She was also instructed to use cool compresses. States did began both the BENADRYL and the compresses, however on 10/15/08 the area had spread to the middle of her forearm and the itching was not being controlled by the BENADRYL. States she also had aching and chilling but never ran a fever. Stated her last TD was "many years ago." States saw DR for an evaluation. States Dr measured her arm circumference and her left arm was 3 inches larger than her right. States Dr placed her on KEFLEX and ibuprofen. Pt called the health department to report the adverse even on 10/16/08. Pt stated she was no longer having chills and the over all achiness had improved. However she was still having problems with itchiness. States her arm had decreased one inch from 10/15/08 when she started on the antibiotic. I asked at that time if she would given me permission to talk with Dr to let him know of her improvement and to see if he wanted to add anything to her treatment. Pt gave me permission to contact Dr. Phone call to Dr stated that he could started her on steroid dose pack for the itching. I stated I would check with pt and call him back. Phone call to pt explained to her that Dr could start her on steroid dose pack for the itching. Pt stated she would like to start on the steroid because the itching had not improved. I then asked about the status of her overall health. Pt then stated she had shingles 2 weeks ago but before the Tdap vaccine she was much improved and back to work. I explained to her that because she had the shingles it was not a contraindication to the Tdap vaccine and because of the job she had she was at great risk for spreading pertussis. Pt also states she had hypertension that was controlled with medication. Pt stated she was ZIAC 10 mg 1 per day, ESTRADIOL 0.5mg, And she takes DIACLOFIENAC to decrease pain from osteoarthritis. States also had her flu shot in her left arm "a couple of weeks ago" at Dr's office. I asked pt is she would not mind contacting Dr's office for the manufacturer, date given, and lot number of the flu shot she received. Called Dr and explained the medications pt was currently taking and that pt stated the itching had not improved. Dr stated he would call her in a steroid dose pack. Phone call from pt stated she had her influenza vaccine on 09/17/08 in her left arm. Stated the manufacturer was GlaxoSmithKline and the lot number was 8FLLA18AA. Informed pt that Dr was calling in a steroid and that I would contact her tomorrow to see if the swelling and itching had improved. RNBSN late note 10/17/08 phone call to pt left voice mail stating I wanted to check on her and make sure she had been able to start the steroid. RNBSN. Late not 10/20/08 phone call to pt stated she was much improved the swelling, itching, and redness was totally resolved. Encouraged pt to contact the health department if she had further concerns. RNBSN.