54 year old female with allergic reaction following smallpox vaccination. Received epi-pen injection X 1, and took benedryl for 2 days following. Description from nurse at vaccination clinic below.  -Patient RECEIVED THE SMALLPOX VACCINATION ON 4/23/03 AT ABOUT 2:45 PM  - AND ABOUT 20  - MINUTES LATER AT 3:05 PM, ANAPHYLACTIC SYMPTOMS BEGAN.  SHE TOOK A  - CLARINEX PILL AT THIS TIME.  SHE  - HAD A HISTORY OF ANAPHYLACTIC REACTIONS TO SHELLFISH (ONCE, 20 YEARS  - AGO) AND VINEGAR (TWICE, ONCE 12 YEARS AGO AND ONCE 5 YEARS AGO), AND  - A MD IDENTIFIED ALLERGY TO BEE  - STINGS (THOUGH HAD NEVER BEEN STUNG) AND SO WAS CARRYING EPINEPHRINE  - WITH HER AT THE TIME SHE WAS  - GIVEN THE SMALLPOX VACCINATION ON LEFT ARM.  PATIENT EXPERIENCED AN  - UNCOMFORTABLE  - FEELING RISING INTERNALLY FROM HER BELLY AND RISING INTO HER CHEST.  - AT THIS POINT, patient REALIZED THAT SHE WAS HAVING AN ANAPHYLACTIC  - REACTION AND SO ASKED FOR HELP.  DR ADMINISTERED THE  - EPINEPHRINE TO patient IN HER RIGHT THIGH AT APPROXIMATELY 3:15 PM.  DR.  -MD RECOMMENDED THAT Pt BE OBSERVED FOR 4 HOURS AFTER THIS  - EVENT AND IF SHE EXPERIENCED FURTHER SYMPTOMS, SHE COULD TAKE A  - BENEDRYL TABLET FROM HER OWN SUPPLY.  AT 3:30 PM, pt WAS LUCID,  - PALE,IN A SUPINE POSITION, AND DESCRIBED FEELING NAUSEOUS AND DIZZY.  - HER PULSE WAS RAPID, WEAK, AND REGULAR.  ABOUT 15 MINUTES LATER, pt  - LEFT. ENROUTE patient WAS GIVEN ANOTHER BENEDRYL AT  - ABOUT 4:30 PM FOR CONTINUED NAUSEA AND SHAKINESS.  SHE HAD ONE BOUT OF  - DIARRHEA ON THE WAY Back.Pt MET HER HUSBAND WHO DROVE  - HER THE REST OF THE WAY TO HER HOME,  - UPON ARRIVAL TO HER HOME, pt  EXPERIENCED ANOTHER BOUT OF DIARRHEA.  -   HER VACCINE SITE WAS REDRESSED AS THE ORIGINAL DRESSING HAD COME  - OFF.  pt's HUSBAND WAS EDUCATED IN HOW TO ADMINISTER EPINEPHRINE IF  - NEEDED AND TO CONTACT 911 IF SHE FELT SHE WAS HAVING ANOTHER REACTION.  -   HE CALLED pt's PHYSICIAN WHO RECOMMENDED THAT pt TAKE BENEDRYL  - EVERY 4 -6 HOURS.  - ON 4/24, pt STATES SHE SLEPT LATE, BUT WAS FEELING BETTER, THOUGH  - STILL SHAKEY AND WEAK.  SHE WAS DRINKING ALOT OF WATER, AND HAD EATEN  - ONCE BY MIDDAY.  - ON 4/25, pt WENT TO SEE HER PHYSICIAN DUE TO A FEW SMALL VESICLES  - THAT APPEARED LEFT FOREARM.   RN WILL  - PHOTOGRAPH THEM ON 4/26, ALONG WITH THE VACCINE SITE WHICH IS  - REDDENED, PER pt.  OTHERWISE,pt CONTINUES TO FEEL BETTER.  - TWENTY-FOUR HOUR FOOD HISTORY FOR pt PRIOR TO VACCINATION:  - APRIL 22 - 6 AM  FRENCH BREAD  -            12:30 PM - PROVOLONE CHEESE SANDWICH ON RYE WITH MAYO,  - POTATO CHIPS, DECAF COFFEE WITH HALF AND HALF.  -       3:30 PM - BABY RUTH, AND M & M M S WITH PEANUTS  -       5 PM - PEPSI  -        5:30 PM - BROCCOLI, LAMB WITH SAUCE, TOAST WITH FRENCH BREAD,  - BUTTER. DINNER LEFT OVER FROM BOATYARD GRILL RESTAURANT.  -             8 PM - CAFFINATED TEA WITH SUGAR AND SOY MILK  - 4/23  6:45 AM - BUTTERED TOAST, FRENCH BREAD, BUTTER, COMMERCIAL  - TEA,WITH LATTE(MILK AND SUGAR)  -       9 AM  - PLAIN BAGEL, CREAM CHEESE, GREEN MELON, GLASS OF  - CRANBERRY JUICE  -       12:30 AM APPLE, ROLL, TURKEY, MAYO PACKET, PEPSI, WATER  - HOME VISIT TO pt ON 4/26.  SHE STATES THAT ON THURSDAY AND FRIDAY  - AM SHE NOTICED FOUL SMELLING URINE, BUT NOT TODAY.  STATES THAT ON  - 4/25 AT ABOUT NOON SHE NOTICED A TINGLING SENSATION ACROSS HER BACK  - AND OVER HER ARMS AND SLIGHT STOMACHE BLOATING.  THEN SHE DEVELOPED  - RAISED WELTS AND A RASH ON RIGHT FOREARM WHICH IS GONE TODAY 4/26.  - ALSO SHE DEVELOPED 4 LITTLE VESICLES ON HER LOWER LEFT FOREARM NEAR  - HER WRIST, THAT LOOKED LIKE POISON IVY.  THE TINGLING, HEATING UP  - SENSATION ON HER ARMS AND BACK, LASTED UNTIL ABOUT 4 PM ON 4/25. SHE  - WENT TO SEE HER PHYSICIAN ON 4/25/03.  - TODAY, THE 4 SPOTS ON LEFT FOREARM ARE NOT VESICULAR AND VERY SMALL  - REDDISH DOTS.  DIGITIAL PHOTOGRAPH WAS TAKEN OF THIS AREA AS WELL AS  - THE VACCINATION SITE, WHICH HAS DEVELOPED A VESICLE AND IS REDDENED  - AROUND IT.  - ON SUNDAY, 4/27, pt, VIA TELEPHONE CONVERSATION, STATES THAT SHE IS  - FEELING MUCH BETTER.  HER STOMACHE STILL OCCASIONALLY IS FEELING  - BLOATED.  THE AREA DISTAL TO THE VACCINE SITE NEAR HER LEFT WRIST  - TODAY ONLY SHOWS ONE TINY RED SPOT REMAINING AND IT IS VERY DRY.  - TELEPHONE CONTACT TO PATIENT ON 4/28/03. pt STATES THAT SHE  - EXPERIENCED CHILLS LAST NIGHT AT 10 PM AND THEN HAD A RASH OVER HER  - BODY. SHE TOOK A BENEDRYL AT ABOUT 12:30 PM, AND IN THE MORNING TODAY,  - HER RASH WAS GONE. SHE SAW HER PHYSICIAN TODAY.  THE PHYSICIAN TOLD  - HER TO TAKE BENEDRYL EVERY 6-8 HOURS. ON WEDNESDAY, THE DOCTOR SAID  - SHE CAN GO BACK TO WORK IF NO OTHER REACTIONS OCCUR.  ON WEDNESDAY,  - pt IS TO TAKE ONE CLARINEX IN THE MORNING AND TWO BENEDRYLS IN THE  - EVENING.  Outbreak Related - 1/Sporadic CaseCase Status - 1/Confirmed     Received by County - 04/25/2003