Age: 42.0
Sex: F
Vaccine: SMALL
Symptoms: Dizziness, Fatigue, Headache, Myalgia, Nausea
Clinical narrative: 2/21/03: Smallpox vaccine taken. Rash, tight jaw, and tight scratchy throat 45 minutes to 1 hour after taken. Headache and pain at site and down arm to elbow. Staff notified along with other staff members in unit saw rash. 2/22/03:  Rash on face, neck, arms, hands, abd, increased itching, headache, facial congestion, temp 100.2. Notified Dr. through ER. Ordered to take Benedryl q6hrs Sat and Sunday then change to Claritin qd until rash, itching gone. 2/23/03: Continued rash, itching and headache, started feeling really bad, same as day before but starting to get worse. 2/24/03:  Went to work feeling really tired, extreme fatigue, muscle aches, general malaise, headache temp 100.4, rash continued. Site red with pustule approximately 6mm. 2/25/03:  At work feeling extreme fatigue all other the same as the day before, ears itching on inside with tight pressure and pain. Lymph nodees swollen.  Site 1 cm in size. Started Benedryl due to increase rash and itching. Left unit at about 12:00. 2/26/03: Missed work, feeling extreme fatigue, severe body aches, temp 100.6, unable to take Tylenol or Advil due to sensitivity that cause increased rash with itching. Continued Benedryl. 2/27/03: Missed work, continue to feel the same, alot of sleep required at present about 18 hrs a day. Taking Claritin. 2/28/03:  Missed work. Scab formed on site tegaderm pulled skin off at site and around it edema noted around where tegaderm was located, due to scab forming. No problem with site oozing to have distal lesions, continue to have all problems as before on previous days. 3/01/03:  Increase fatigue increase amount of sleep needed extremely tired with major body aches. Rash continues. 3/02/03:  Went with family to eat breakfast after unable to function. A lot of pain and fatigue. Slept rest of day and night. 3/03/03:  Went to work. Felt like in a bubble, unable to concentrate on tasks that needed to be done. Left work early then slept all afternoon into early evening. 3/04/03:  Notified MD of continued problems, requested to see PMD. 3/05/03:  Saw MD, stated allergic reaction to vaccinia. To continue with Benedryl PM and Claritin daily. Ordered lab. WBC 11.7. Lymph 4.1. 3/06/03:  Scab off, continue to feel awful, no energy. 3/07/03:  Same as day before. 3/08/03:  Slept all day due to extreme fatigue, continued headache with severe body aches. 3/09/03:  Unable to spend time with family due to general "feeling awful" from head to toe even my hair hurts. 3/10/03:  Went to work, very hard to do my job, unable to concentrate due to extreme pain in muscles. 3/11/03:  Continue as day before. 3/12/03:  Seen MD in ER (per MD request to see a dermatologist but none in this area would see me.  My PMD made appt. with MD. Stated continued to have rebound allergic reaction to vaccinia, gave me DCN-100 for pain. Took 1 DCN-100 about 1hr later, became very lightheaded with nausea and vomiting. Relieved pain but side effects not good. 3/13/03:  Missed work. Continue as before. 3/14/03:  Missed work. Same as before. 3/15/03:  Same as before. 3/16/03:  Same as before. 3/17/03:  Per MD request dip urine done. Bili +. Protein 30 mg/dl. Ascorbic acid +. PH 6. Specific gravity 1.015. Lueko ca25. Results faxed to his office. 3/18/03:  Repeat dip urine results same as day before. Continue as before. 3/19/03:  Starting to feel worse. Muscle pain increased, headache, facial congestion returning, restarted Benedryl. Lab drawn. WBC 11.6. Lymphs 4.2. 3/20/03:  Missed work. Slept all day. 3/21/03:  Missed work. 3/22/03-3/23/03:  Weekend felt really bad. 3/24/03:  Went to work did "light" paper work reports, etc. 3/25/03:  Follow-up appt with MD. Started 10mg Prednisone qd. To see again on 3/27/03. Ordered off work for the rest of week to re-evaluate on Thursday. Lab drawn. Post pred. WBC 10.4. Lymph 3.2. 3/26/03:  Same as beffore. Worked half day due to interview scheduled with possible LPN hire and immunization vaccine report to complete. 3/27/03:  Rash again on neck arms, hands, abd and face. MD increased pred to 30mg for 2 days then to return to 10mg qd. Off work. 3/28/03:  Off work. Itching with rash continues. 3/29/03-3/30/03:  Weekend. Slept. Continues to increase. 3/31/03-4/06/03:  Off work. Energy level not returned. Continue to have pain, rash, etc. 4/07/03:  Worked half day. Energy level very low. Exhausted. 4/08/03:  Continue as day before. 4/09/03:  Left at 11:00 feeling really bad. Extreme fatigue. 4/10/03:  Off work. Extreme fatigue. Muscle aches. Headache. Follow-up with MD 4/15/03.