Age: 40.0
Sex: F
Vaccine: TDAP, TDAP
Symptoms: Swelling
Clinical narrative: Initial report received from a health care professional on 25/Oct/2005. A 40-year-old female patient received an intra-muscular injection of Adacel, lot number C2151AC, in the left arm on 06/Oct/2005 at 12:30 PM. 13 days later, on 19/Oct/2005, the patient developed weakness, facial numbness, swelling and fatigue. She also had pain and numbness in her neck and upper back. No other information was provided. The patient's recovery status was not reported. This report was submitted to VAERS by the initial reporter (online VAERS e-report number E-9613). (OMIC) Follow-up report was received on 13/Jan/2006 from the physician. The patient had a pre-exiting history of a dog bite that was received to the left 4th digit on 04/Oct/2005, hypertension, depression, anxiety, chronic allergies, hay fever, asthma, chronic sinus headaches, fatigue and hives in the axillary area. Prior to 06/Oct/2006 she had angioedema, tingling in arm particularly in the left arm, left face and left leg. This was thought to be related to an allergy to Lisinopril. She also had a pre-existing condition of various aches and pains in her chest. The patient was seen on 06/Oct/2005 for treatment for the dog bite received on 04/Oct/2005. The patient was currently taking Albuterol MDI, PATANOL, Aspirin, Fish oil concentrate, FLONASE, ADVAIR Diskus, Multi-vitamin, Benzepril/HCTZ, LEXAPRO and ZYRTEC. She had a terrible prior couple of weeks. At the time of the visit she has just recovered from what was thought to be a previous allergic reaction to Lisinopril that caused angioedema of the face. She was previously seen in the emergency room for this and was placed on steroids and antibiotics and the Lisinopril was discontinued and she was started on MICARDIS. At this visit the patient complained of various aches and pains in her chest and tingling in the arms, particularly her left arm, left face and left leg. The patient had previously had an MRI of the brain that was unremarkable. On exam it was noted that the patient appeared a little anxious but in no distress. There was no current swelling in her face, edema in her extremities or detection of any numbness or weakness. At the patients request an EKG was done and it showed Normal Sinus Rhythm. She was diagnosed that day with perceived numbness (hands, etiology unknown, probably related to the ordeal of the last few days). It was decided to go ahead with the ADACEL vaccination and she received the 0.5 ml dose of ADACEL, manufacturer sanofi pasteur, Inc., lot number C2151AC, expiration date 04/May/2007, intramuscularly in the left deltoid. 20-30 minutes post-vaccination there were no immediate adverse reactions noted. The patient was re-evaluated on 19/Oct/2005 and complained of having a cold and cough for one week. On exam it was noted that she had some shortness of breath and muscle aches. She was diagnosed with bronchitis. A Potassium level was drawn that day and it was within normal limits. The patient was again seen by a physician on 20/Oct/2005. She complained of swelling to her lip, particularly on the left side of her face that started two days prior. This comes and goes. She took some BENADRYL and it went down a little bit but got worse later. She was seen in the emergency room on 19/Oct/2005 where she was diagnosed with angioedema. At that time, it felt she was having a reaction to benazepril. The benazepril was stopped, and she was started on hydrochlorothiazide. In the emergency room she was given an EPIPEN (which she had not used yet), started on Prednisone 60mg daily and PEPCID 20mg b.i.d. Her exam on 20/Oct/2005 revealed a few urticarial lesions other places on her body. She had not had any swelling of the throat and no shortness of breath or headache but had a runny nose and itching in the back of the throat. Her exam that day revealed a clearly swollen face on the left side more than the right. Her diagnosis that day was angioedema (Most probably caused from her ACE inhibitor). A CBC, comprehensive metabolic panel and TSH level were drawn and they were within normal limits. On 24/Oct/2005 the patient was seen by a physician for feeling tired, weak in the face, with facial, tongue and left scapular numbness, a knot in her throat and elevated blood pressure of 168/150. She felt like the whole left side of her face was being pulled down. Her ears were hot and she felt like she had a knot in her throat. Exam that day revealed a very fatigued appearing patient. She was diagnosed with facial and axillary area numbness (possibly related to the ADACEL vaccination). The patient was again evaluated on 01/May/2005. She was feeling better but still had numbness in her left hand and foot, and ache in the left hip, knee, elbow, and shoulder. An EKG was completed that showed Normal Sinus Rhythm. She was to see a Rheumatologist for follow-up on that coming Friday. The patient was again seen by a physician on 08/Nov/2005 for follow-up of the facial numbness. The patient was still pretty achy in the shoulders. Her left hand and toes get numb. She is achy in the knee, shoulder and elbow on the left, a little also even in the forehead. She was feeling a little bit more blue that day. She was diagnosed with arthralgias and myalgias that could be viral but could still be a reaction to the ADACEL. The patient was again seen on 21/Nov/2005. She had paraesthesias and numbness, particularly on the left facial region. She stated it was now just slightly on the left foot and leg which she did have in the past, off and on. She notes it a little bit in the arm and none on the face. Her diagnosis was paraesthesias and numbness, left-sided, seems to be slowly resolving etiology unknown. At the time of this report the patient had not recovered from all the adverse events.