6-12-17 Client experienced dizziness, lightheadedness, shaking chills, teeth chattering, anxiousness, and chest heaviness within 15 minutes after receiving #2 Rabies vaccination. Had client lay down with cold pack behind neck and juice to drink. Checked vitals-WNL. Client stated she felt better after approx 30 minutes. Client stated she had experienced shakiness/chills after receiving #1 rabies vaccine at ER on 6/7/17. Escorted client to husband's truck-husband to drive client home. Advised client to rest, hydrate and contact provided if sx worsen. For future shots give client juice and have client lay down for vaccination. Have client continue to lay down for at least 15 minutes after vaccination. 6-14-17 Client called regarding getting her next rabies vaccination. Reports that after her last rabies vaccination she felt heaviness in her chest through the night which has since subsided and she has since had soreness throughout her body. Had chills only for about 5 minutes after her first vaccination with RABAVERT in the ED. Is wondering if she can go to ED to get her subsequent vaccinations as she is wondering if she will again have a reaction with the IMNOVAX brand that we give here. Advised her to go to the ED to get vaccinations and be sure to let them know of her past reactions so they can be prepared for any life-threatening reaction. Let her know that they can call us if there are any questions regarding why she is there. She can bring record of her vaccinations back in to be entered with record. Telephone Note: Phone call with pt regarding #4 Rabies vaccine in ER on 6/23/17. She stated she took oral BENADRYL prior to receiving the Rabies, and discussed it with ER doctor. She stated he tried to talk her out of receiving this Rabies shot, given her reaction history, but she explained that the CDC Rabies specialist had advised that she complete the series due to exposure history. She reported moments after receiving #4 Rabies vaccine, she felt strong upper abdominal cramping stating it felt like her diaphragm was cramping. She reported shortness of breath, and even when was able to inhale, felt she was unable to get enough oxygen. The ER doctor administered ATIVAN IV as soon as her symptoms started, which relieved the symptoms somewhat. Her feet and hands went numb. She reported diarrhea for one day following the event, abdominal tenderness for several days afterwards and intermittent dizzy spells for the week after the reaction. States doctor said she may have been experiencing "abdominal anaphylaxis". Pt states as of this day, she had no residual symptoms. VAERS form completed and submitted. Received call from client with update on dose #3 RABVERT from ER on 6/16/17. Reports that she had similar symptoms as the previous two doses with shakiness and chills and tremors, a sensation of "closing in", some chest heaviness and SOB. States that her BP dropped to 90/52 and her heart rate increased. She newly experienced numbness/tingling in her hands up to her elbows. States she was administered oral BENADRYL while in the ER and that seemed to help with the chest heaviness. After discharge home, she experienced a "tight abdomen" with shooting pains for the next 24 hrs. Also reported feeling dizzy and an intractable headache for 24-36 hours. Consulted CDC Rabies, Dr, regarding client's reactions to the PEP series. Based on exposure history, completing PEP is recommended with supportive therapies as needed in the ER. Agency is also aware of client reaction. Client was notified that she should finish the PEP series as planned at the ER. She is to notify agency after the final dose is received and we will complete a VAERS report for the whole PEP series. Client states understanding and is agreeable to plan.