This case was reported by a pharmacist and described the occurrence of dizziness in a 48-year-old male subject who was vaccinated with ENGERIX B (GlaxoSmithKline), FLUVIRIN (non-gsk). Concurrent medications included hydrochlorothiazide and lisinopril. On an unspecified date and 12 November 2008 the subject received 1st dose and 2nd dose of ENGERIX B (1 ml, unknown, left arm), on unspecified dates the subject draws up doses of FLUVIRIN. At an unspecified time after vaccination with ENGERIX B, the subject experienced dizziness, fatigue, elevated blood pressure, knee pain, lightheadedness and nausea. At an unspecified time after working with FLUVIRIN, the subject experienced accidental exposure to drug and inappropriate preparation of medication. The pharmacist reported he had some dizziness following the1st injection of ENGERIX B. The pharmacist reported he received the 2nd dose of ENGERIX B on 12 November 2008 and the next day went to a meeting. During the meeting he felt lightheaded and nauseous. He left the meeting, went outside and another healthcare professional checked his blood pressure and found it to be 210/110. He then went to the emergency room and had a workup that included an electrocardiogram (EKG) and lab work. He was given an oral dose of metoprolol 25 mg and intravenous dose of ATIVAN. He was told the EKG and lab work were normal and was referred to his primary care physician. He saw a nurse practitioner with his primary care physician a few days later and the diuretic was removed from his medications and a low dose of ATIVAN was added. He has continued to have fatigue. Also he notice that he had pain in his right knee on 14 November 2008 that was like a pulled ligament or tight muscle. He was out of work several days and will be returning to work this weekend. His BP today was 119/70 but he continues to have some fatigue occasionally although it has improved. He reported that he had stress as a pharmacist and he has been drawing up FLUVIRIN without gloves. He says some of the flu vaccine has gotten on his hands during the process of drawing up 500-800 doses of flu vaccine. The subject was treated with metoprolol and ATIVAN. At the time of reporting the events were unresolved. The pharmacist considered the events were probably to vaccination with ENGERIX B and FLUVIRIN. Follow-up information was received on 24 November 2008, via pharmacist who reported experiencing additional events of increased heart rate, anxiety, loss of appetite and warm burning feeling after vaccination with ENGERIX B. The pharmacist reported he ate broth and pasta this morning, he now feels okay, but he knows he will become fatigued by this afternoon. He state he continues to experience a warm burning feeling through his chest and shoulders. He wakes up every morning with this sensation. He stated his primary care physician thinks he may be having panic attacks; he is now taking CELEXA and XANAX XR. He feels these events may be a combination of receiving the ENGERIX B vaccine and stress from his job as a retail pharmacist. The pharmacist questioned whether the particular lot could be causing these adverse events, "there was nothing physically wrong with the vaccine". Follow-up information was received on 10 December 2008, via subject who is also a pharmacist, to correct several inaccuracies in the previous reports. The subject reported he was taking fosinopril instead of lisinopril in combination with hydrochlorothiazide. The initial report stated that "some of the flu vaccine had gotten on his hands while drawing up 500-800 doses, he indicated that his facility has only given about 500 vaccines since October and that he has only administered about 100 of these flu vaccines. The Flu vaccine only gotten on his hands one time". He wanted to be sure that we were aware that he personally ahs not been given the flu vaccine. He began taking CELEXA on 21 November 2008 and XANAX XR sometime after 24 November 2008. His symptoms have since let up after taking these medications. He also stated that these adverse reactions began the day after receiving the ENGERIX-B vaccine. He felt that it may have started it all off but that the stress of being a retail pharmacist and his borderline hypertension may have added to these symptoms. Follow-up information was received on 17 June 2009 from Quality Assurance. Per the Quality Statement, the ENGERIX vaccine lot AHBVB596AA met requirements of their specifications and was suitable for vaccination purposes.