Age: 44.0
Sex: F
Vaccine: FLU3
Symptoms: Anxiety, Chest X-ray normal, Dyspnoea, Hyperventilation, Hypoaesthesia
Clinical narrative: Initial report was received from a consumer, who was the patient, who included medical records on 15 October 2012. The reporter also is the same reporter (same patient) for another case: 2012-05598. A 44-year-old female patient received dose two of a left deltoid intramuscular injection of 0.5 milliliters (mL) of FLUZONE, sanofi pasteur Inc., lot number U1418AA, on 02 November 2004. The patient went to the emergency room on 05 November 2004 and stated she began having some symptoms after receiving a flu shot on Tuesday, three days ago, (02 November 2004). The patient stated she had been having sensation of shortness of breath, numbness and tingling around her mouth and numbness and tingling in her fingers. On 05 November 2004, three days after vaccination, the sensation of shortness of breath got significantly worse and she developed some spasm of her hands bilaterally to the point where she was unable to move her hands. She was also complaining of some right-sided pleuritic chest pain and denies any other associated symptoms. Review of systems was positive for symptoms mentioned in history of present illness. All other systems were reported as negative. Blood pressure was 136/94mmHG, pulse was 98, respirations were 18 and mildly labored, but significantly hyperpneic, temperature was 97.1 degrees orally, and oxygen (O2) saturation (sats) were 100% on room air. She did have some right lateral chest wall tenderness that reproduces the pain that brought her to emergency room, however, there was no bony air crepitus over this region. On "psychologic" exam, the patient was significantly anxious and hyperventilating. She did have some intermittent carpal spasm. Diagnostic testing included: PA and lateral chest x-rays which were entirely normal. Treatment included: The patient was taught slow breathing exercises and she was given ATIVAN 2 milligram (mg) by mouth (po). After the ATIVAN and breathing exercises, the patient's symptoms completely resolved and the patient felt significantly improved and ready for discharge from emergency room. The patient was diagnosed with panic attack, hyperventilation syndrome and carpal spasm. The patient was discharged home on ATIVAN, and instructed to follow-up with her primary care physician as needed. The patient's past medical history was significant for anxiety disorder with panic attacks and hypothyroidism. She had no known medical allergies. The patient denied alcohol or tobacco consumption. Family history was reported as non-contributory. Concomitant medications included LEVOXYL. Vaccination records from 23 October 2003 and 02 November 2004 reported the patient had none of the following (No): severe allergy to eggs; severe allergy to latex; severe allergy to thimerosal; previous reaction to influenza vaccine; ill appearing with increased respiratory rate, moderate fever (>101.0) and increased heart rate; history of paralysis from Guillain-Barre Syndrome or history of bleeding problem. The patient received one dose of a left deltoid intramuscular injection of 0.5 mL influenza vaccine, manufacturer reported as Evans, lot number 765703 on 23 October 2003 and she had the following adverse events: felt unable to breathe, heart was racing, bad reaction, felt not well on an unreported date, noted in linked case 2012-05598 (However, the consumer also reported as "No", previous severe reaction to influenza vaccine in her 2003 and 2004 vaccination records). The patient's outcome was reported as recovered (symptoms completely resolved) on 05 November 2004. Documents held by sender: medical record, vaccination records.