she began choking; condition worsened; She awoke very early in the morning, when her tongue was too swollen to fit in her mouth; having trouble with secretions; couldn't swallow; tightness in her chest; leaving small "pockmarks" in the areas where her hives had been; anaphalactic reaction; within the hour, she began itching; develop hives after getting home from work; Initial information was received on 06-Dec-2021 regarding an unsolicited valid serious case from a nurse (under Medical Information (MI) Inquiry Number: 00886277).  This case involves a 58 years old female patient who began choking, anaphalactic reaction (anaphylactic reaction), within the hour, she began itching (pruritus), develop hives after getting home from work (urticaria) condition worsened (condition aggravated), she awoke very early in the morning, when her tongue was too swollen to fit in her mouth (swollen tongue), having trouble with secretions (Saliva altered), couldn't swallow (dysphagia), tightness in her chest (chest discomfort)and leaving small "pockmarks" in the areas where her hives had been (skin discolouration) after receiving vaccine INFLUENZA QUADRIVAL A-B MULTIDOSE VACCINE PRESERVED [FLUZONE].  The patient's past vaccinations included INFLUENZA VACCINE.  The patient's medical history, medical treatments, concomitant medications, and family history were not provided.  On 11-Oct-2021, the patient received a 0.5 ml dose of suspect INFLUENZA QUADRIVAL A-B MULTIDOSE VACCINE PRESERVED (lot number: UJ694AA and expiry date: 30-Jun-2022) via intramuscular route in unknown administration site for prophylactic vaccination.  On 11-Oct-2021 the patient developed a serious anaphalactic reaction (anaphylactic reaction), within the hour, she began itching (pruritus) and develop hives after getting home from work (urticaria) same day following the administration of INFLUENZA QUADRIVAL A-B MULTIDOSE VACCINE PRESERVED. These events were assessed as medically significant. The patient always took a flu shot, so she did not associate the itching with the vaccine, she thought maybe she had used a different laundry detergent or something.  She took DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) orally and went to bed.  On an unknown date she awoke very early in the morning, when her tongue was too swollen to fit in her mouth (swollen tongue), She went to a nearby urgent care, as she was having trouble with secretions (saliva altered), couldn't swallow (dysphagia) (unknown latency).  At the urgent care, her condition worsened (condition aggravated) she began choking (choking) This event was assessed as medically significant and experiencing tightness in her chest (chest discomfort). Within 30 minutes of awakening, she was transported to the emergency department following the administration of INFLUENZA QUADRIVAL A-B MULTIDOSE VACCINE PRESERVED.  In emergency department (ED) she received METHYLPREDNISOLONE SODIUM SUCCINATE (SOLUMEDROL), EPINEPHRINE and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) via intravenous not otherwise specified (IV NOS). She stated that as soon as she received the intravenous (IV) epinephrine, her symptoms began to subside.  She remained in emergency department (ED) for six more hours, for observation.  Patient stated that she required medication with these, and oral BENADRYL every 6 hours for about a week. Her symptoms gradually went away, leaving small pockmarks in the areas where her hives had been (skin discolouration).  The patient was discharged with oral steroids and topical MOMETASONE.  She wanted allergy testing, to determine sensitivity, so she was requesting list of all ingredients.  At the time of reporting, the patient recovered from anaphylactic reaction, pruritus, urticaria, condition aggravated, swollen tongue, saliva altered, dysphagia, choking, chest discomfort and was recovering from skin discolouration.