Age: 18.0
Sex: M
Vaccine: FLU3, FLU3
Symptoms: Urticaria
Clinical narrative: Initial report received from a health care professional on 01 April 2011. An 18 year-old male patient who is allergic to shrimp and some beans, had received an annual intramuscular left deltoid injection of FLUZONE (lot number U3743AA) and a right forearm injection of APLISOL (King pharm, lot number 148603) on 31 March 2011 at 10:00 am. Approximately 3 hours later at 13:00 pm, the patient returned to the physician office with generalized redness, hives and difficulty breathing. His O2 (oxygen saturation) was decreased and he was medicated with Epinephrine (route not reported) and transported to the ER (emergency room) via ambulance. The patient was again medicated with epi and BENADRYL with resolution of symptoms and without hospitalization. The patient had denied any concurrent illnesses of other medical conditions, but does take concomitant ACCUTANE (indication not reported). The patient had denied any adverse events with prior vaccinations. Follow-up information was received from a health care professional on 09 May 2011. The patient returned to the physician office on 31 March 2011 at 1305 after lunch and playing soccer complaining of a rash, facial swelling, shortness of breath and felt like his throat was closing up. His initial oxygen saturation was 90 - 94 % on room air. He was administered 1 cc of subcutaneous Epinephrine in the left arm and a face mask with oxygen was placed with 1 L of oxygen. His O2 (oxygen saturation) was then 96 - 98 %. The patient was transferred to the emergency department (ED) via ambulance. The patient arrived in the ED at 1330 with a chief complaint of an "allergic reaction". He was alert and oriented, in "no acute distress" and his O2 saturation was 98% on room air. Physical exam revealed a blood pressure of 170/79, heart rate 112 regular, respiratory rate 19 with normal breath sounds and no use of accessory muscles, wheezes or rales. The mild skin rash was fading. Treatments in the emergency department included 0.3 mg of Epinephrine intramuscularly (IM) right deltoid, BENADRYL 50 mg IV and 25 mg orally before discharge, PEPCID 20 mg diluted in 5 ml slow IVP (intravenous push). At 1629 the patient was discharged from the emergency department stable and in good condition. On 06 April 2011, the patient was evaluated by a physician in an asthma and allergy clinic. According to the physician, the angioedema and anaphylaxis following exercise was likely associated with the consumption of food containing chili. The patient was known to have an allergy to ingredients in chili. His reported lunch on the day of the event likely contained some chili. Treatments included a short taper dose of Prednisone 10 mg tablets: four tablets by mouth everyday for three day, three tablets everyday for three days, two tablets everyday for three days and then one tablet a day for three days; a large volume nebulizer; and testing for common foods and environmental allergens (results not reported). Past medical history included an allergy to chili, a broken collar bone in the 10th grade, torn rotator cuff and wisdom teeth extraction on 21 March 2011. Concomitant medication also included Ibuprofen 800 mg every eight hours as needed for wisdom tooth extraction. According to the report the patient had not had similar symptoms previously. The patient's outcome remained recovered. Documents held by sender: None.