Age: 43.0
Sex: F
Vaccine: RAB, RAB
Symptoms: Feeling cold, Hot flush, Insomnia, Knee operation, Lymphadenopathy
Clinical narrative: Symptom history for patient following Rabies vaccination. General Medical History: No health issues of any kind (other than mild, controlled high blood pressure and migraines controlled by Imitrex) prior to starting rabies vaccination cycle. I am a normally healthy, active person, and had not experienced anxiety or mood swings prior to period described above.  Since migraines were typical for me, I did not start tracking them in this journal until I was diagnosed with encephalitis.  I have had numerous migraine headaches that I treat with Imitrex, in conjunctions with the symptoms below. 11/19  Day 1 Rabies Shot series (following bite by possibly rabid feral cat)  Administered by Emergency room doctors. 11/22  Day 3 Rabies Shot. 11/26  Day 7 Rabies Shot. 12/3  Day 14 Rabies Shot. 12/4 through 12/8  Low Grade Fever. 12/7-12/12- Unusual Low Level Anxiety. 12/7   Met with Primary Care Physician for pre surgery physical. Diagnosed Cardiac Right Bundle Branch Block from EKG. 12/13  Arthroscopic knee surgery, was administered DDAVP via IV for Von Willebrand's bleeding disease (prescribed for surgery by Hematologist after pre-surgical study) -- was also given scopolamine patch for nausea by Anesthesiologist. 12/14 (Morning)  Internal knee bleeding  knee filled with blood  experienced strong pain, dizziness and nausea - was seen on emergency basis by surgeon; was administered additional DDAVP (and told to take on 12/15 as well). 12/14 (Evening) High Anxiety/Panic attack, severe breathing problems, urge to urinate; Went to emergency room at 10pm  problem cleared by 3AM; hospital ran multiple heart, lung and blood tests, but did not find any cause, was discharged with no follow-up. Attributed problems to reaction to Percocet, and prescribed Darvocet to help with post operative pain. 12/17  Day 28 Rabies Shot. 12/18 - Insomnia, High Level Anxiety, pronounced mood swings, hot/cold flashes, trouble breathing. 12/19  Anxiety, pronounced mood swings. 12/20 - Insomnia, High Level Anxiety, pronounced mood swings, hot/cold flashes, trouble breathing. 12/21  Hot/cold flashes, anxiety, mood swings, slight trouble breathing, blurred vision. 12/22  Anxiety. 12/23 - Anxiety. 12/24 (night)  Anxiety, Insomnia, frequent urge to urinate. 12/25 - High level of Anxiety, dizziness, mood swings, nausea, hot/cold flashes, blurred vision, General feel of unwell, frequent urge to urinate. 12/26 - Anxiety. 12/27 (Noon to evening)  Anxiety, dizziness, hot/cold flashes, anxiety, nausea, blurred vision, dried mouth, frequent urge to urinate  saw Office nurse practitioner, was given 1 pill Valium 5mg, anxiety greatly eased by Valium. Was recommended to see Infectious Disease specialist for possible adverse reaction to Rabies vaccine. Called Infectious Disease Specialist, obtained appointment for 1/10/08, was told by office of Infectious Disease Specialist to see primary care physician in interim. 12/28/07  Saw Primary Care Physician and was prescribed 5mg Valium to help ease anxiety.  Primary Care Physician advised to see Infectious Disease Specialist.   Mild anxiety, dry mouth. 12/29/07 (Morning to Evening) - Anxiety, dizziness, mild nausea, hot/cold flashes, dried mouth. Valium eased anxiety. 12/30/07 (Morning) - Mild Anxiety, hot/cold flashes, blurred vision, dried mouth. Valium eased anxiety. 12/31/07 (Noon to Evening)  Mild Anxiety, mild dizziness, hot/cold flashes, blurred vision, mild nausea, urge to urinate. Valium eased anxiety. 1/1/08 (Morning to Evening)  Mild anxiety, blurred vision, hot flashes. Valium eased anxiety. 1/2/08 (Noon)  Mild anxiety, hot flashes.  (3:00-7:00pm)  High level of Anxiety, extreme dry mouth, hot flashes, blurred vision, dizziness. Valium eased anxiety after 7:00pm. 1/3/08 (Morning) Mild Anxiety, Dry mouth. Valium eased anxiety. (Evening) Mild Anxiety, Dry mouth. Valium eased anxiety.  1/4/08 (Morning) Dry Mouth. (Afternoon to Evening)  Mild Anxiety, dry mouth. Valium eased anxiety. 1/5/08 (Morning to late afternoon)  Dry Mouth. (Evening)  - Mild Anxiety, Dry Mouth. Valium eased anxiety. 1/6/08  (1:00AM)  Extreme Dizziness, Nightmares. (7:00AM-1:00pm)  Extremely high Anxiety, difficulty swallowing, hot/cold flashes, nausea, dry mouth, dizziness, frequent urge to urinate. Valium eased anxiety after 1:00pm. (7:00PM to Bedtime) Mild Anxiety, dry mouth. Valium eased anxiety. 1/7/08 (6:00AM-9:00AM) High Level of Anxiety, difficulty swallowing/glands visibly swollen, hot/cold flashes, dry mouth, blurred vision. Valium eased anxiety. (9:00AM) Saw Office Nurse Practitioner and verified low grade fever 99.4.  Began taking Tylenol every 4 hours. Instructed to see Primary Care doctor. (2:00pm)  High Level of Anxiety, Hot Flashes.  Additional Valium eased anxiety. (6:00pm)  Saw Primary Care Physician.  Temperature 98.3, blood pressure 108/70, ruled out throat infection, and drew blood for CBC.  Determined lymph nodes in throat area were swollen and listed cause as "Reaction to Rabies Vaccine". 1/8/08  (7:00AM)  Mild anxiety, lymph nodes less swollen, blurred vision, mild dry mouth. Valium eased anxiety. 9:00PM  Extreme fatigue (no real cause), all over muscle soreness. 1/9/08  (6:30AM)  Mild anxiety, lymph nodes less swollen, all over muscle soreness, blurred vision. Valium eased anxiety, helped reduce soreness. (12:00pm  2:00pm) Mild Anxiety, dizziness, hot/cold chills.    (2:30-900pm) High Level of Anxiety, hot flashes, dizziness, dry mouth.   Took additional Valium. 1/10/08  4:00-9:00AM  Anxiety, muscle soreness, hot flashes.  Valium eased anxiety. 3:00pm  saw Infectious Disease doctor. Was informed that symptoms are not a common reaction to the rabies vaccine.  Drew blood to check thyroid levels.  Informed symptoms were consistent with Brain related encephalitis due to rabies vaccine, but would be extremely rare and needed to rule it out. Was prescribed Brain MRI with contrast.  MRI is scheduled for 1/16/08. 6:00pm  arrived home and received letter from Primary Care Physician saying white blood count was slightly elevated, and would recheck counts in one week. Appointment is scheduled for 1/14/08.   1/11/08  (8:00AM) Mild Anxiety.  Valium eased anxiety. 2:00pm  Met with Cardiologist for Right Bundle Branch Block analysis.  Scheduled Stress test and Echo Cardiogram for March (following knee surgical clearance).  Mentioned bundled block could be caused by virus. 1/12/08  (5:00-7:00AM) High level of hyperactivity. (10:00-1:00pm)  High level of anxiety, hot flashes blurred vision.  (1:00-3:00pm) Mild anxiety, blurred vision. (3:00pm-4:00pm) Higher Anxiety, blurred vision, hot flashes. 4:30pm  Anxiety eased by valium. 1/13/08  -(9:00am) Mild Anxiety. (12:00pm) Anxiety, hot flashes, blurred vision. Anxiety eased by Valium. 1/14/08 (10:00AM) Mild Anxiety, hot flashes, burred vision.  (4:00pm) Met with Primary Care Physician. Prescribed additional Valium for anxiety, but recommended cutting in half where possible.  Redrew blood for CBC. 1/15/08  (6:00am) High level of Hyperactivity. (7:00am)  Anxiety, dry mouth, blurred vision.  5 mg Valium eased anxiety. (3:00pm) Anxiety, dry mouth. Took additional 5mg Valium. (9:00pm)   mild anxiety. 1/16/08   (2:00pm-10:00pm) Strong Headache. (4:30pm) - Took 10mg Valium to prevent anxiety from Brain Scan. (7:00pm) Received letter from Primary Care Physician saying "White Blood count going down. Almost normal. Follow up as needed." 1/17/08   (9:00am) Anxiety, hot flashes, dry mouth. Took 5mg Valium. 1/18/08   (7:00am) Mild Anxiety. Took 2.5mg Valium. 1/19/08   (12:00pm) Anxiety. Took 5mg Valium. 1/20/08   (6:00pm) Mild Anxiety. Took 2.5mg Valium. 1/21/08   No symptoms all day. 1/22/08   (12:00pm) Met with Infectious Disease doctor. Was diagnosed with vaccine related encephalitis, per MRI and lab work.  Sedimentation Rate- Westergren= 60h; C Reactive Protein, Quantative=24.9H. (1:00pm)  Anxiety Took 5mg Valium. (2:00pm) Migraine Headache. Treated with Imitrex. 1/23/08   ( 2:30 pm) Migraine headache. Treated with Imitrex. (8:00pm) Strong Migraine headache treated with Imitrex. Extreme Fatigue. (9:00pm)  Anxiety. Took 5mg Valium. 1/24/08  (3:00am) Strong Migraine Headache. Treated with Tylenol and ice pack. Numbness in right hand. All symptoms gone by 4:30AM.