Age: 58.0
Sex: F
Vaccine: FLU4
Symptoms: Head discomfort, Hypersensitivity, Impaired work ability, Malaise, Nausea
Clinical narrative: Allergic reaction Patient is here for physical (needs hep B titer for work form), but has had two recent ED visits for severe allergy sxs, which seemed to begin after receiving flu vaccine. Chart review shows a similar complaint in August, when she was seen here as a walk in. At that time she did not have an attributable trigger. First episode happened in the evening. Got worse despite benadryl and so came in for evaluation. New job in June, works in a small kitchen. The other person who works with her has also had frequent allergic reactions. She checked with management who couldn't identify a reason but this is the only association she can think of. Sxs resolved, and in retrospect she does not feel that the episode in August is anything like what happened in recent weeks, even a more mild version of same.  She had a flu vaccine at the urging of the manager at her job, on 10/19. After the injection got body aches during the rest of that day, general malaise, restlessness and didn't sleep well, Got up to bathroom and saw her face in the mirror grossly swollen, rash over shoulders and chest and went straight to ED (10/20). Received IV antihistamines and steroids, sxs resolved, discharged with Prednisone. Then as soon as she stopped prednisone her sxs all returned. Felt like her face, head, feet were burning. Returned to the ED on 10/24, recalls she was also having pressure in her chest this time, but no breathing problems, dyspnea, oral swelling. Medicine helepd in the ED (solumedrol, benadryl, pepcid) but next day while getting ready for work she had nausea and weakness, and then on toilet she had a "seizure". Called for her husband when she began feeling bad, and family found her unresponsive against the wall, eyes twitching, foaming from her mouth, then had larger shaking movements of her body. Went back to bed and decided not to return to ED, because she was very tired and had just been there. Reports she did not fall, and does not think she experienced any trauma to her head. Toilet is near the wall, and thinks she sat before the episode really began. Family noted she was leaning against wall and seated on toilet when they reached her. Since that time, feels like her vision is blurred, head feels as though she is wearing a helmet. Has poor distance vision which is a change from before the seizure. None of this has recurred since, and no further hives since second course of steroids. ROS: Ever since flu vaccine/10/20, has not slept well. Feels restless Had headaches until 2 days ago, not sure what helped them resolve but there was a healing service at church. Has Abd pain, epigastrium, hurts when she eats or drinks. Feels nauseous, no vomiting Feels weak and tired all the time. Has lost some weight, 5 pounds in past week. Tries to eat 3 meals per day to help her health even though not hungry. When she had hives, felt flushed, but otherwise no fevers. Denies floaters, flashes, ocular pain, redness of eyes. Wears glasses that don't seem to work as well as before. Denies focal neuro sxs of numbness, weakness, clumsiness, but endorses generalized weakness. Symptoms have been unchanged or slightly improving since 10/25 event. Vision change is staying the same. No headache today. Flu vaccine information provided by her employer: FLUONE QUADRIVALENT UIA26AE Ned code 49281-626-15 2017-18 formula Sanofi-Pasteur Exp: 6/13/18 Used to work 8 hours with no difficulty. Today was the first time she was able to work all day since these sxs began Intermittently has mild tingling and burning sensation around her mouth and over both cheeks, this worries her because allergic reaction began that way. She has allergy appt scheduled in early December.