Age: 28.0
Sex: M
Vaccine: DT
Symptoms: Immediate post-injection reaction, Incorrect route of product administration, Injection site paraesthesia, Magnetic resonance imaging, Mobility decreased
Clinical narrative: Issue: I have been dealing with nerve pain in my left arm from a terribly placed tetanus shot (Td) by immunizations since 22 Feb 21. I felt pain immediately after the shot. On a 1-10 scale, this pain stays at a 7 every hour of every day, with a break only occurring at night due to the CNS depressants (Flexeril) and Lidocaine patches. I have pins and needles type tingling flowing from the injection site all the way down to all fingers on the left arm. The second I wake back up; the pain cycle repeats. I have lost most of my range of motion in that arm (at least 50%). Believe this condition to be SIRVA (Shoulder Injury Related to Vaccine Administration).  Record of ?care?: 22 February 2021: The nurse who administered the immunization did not project or estimate where she would place the shot or bunch up the muscle with her hand, she simply jabbed it near my shoulder bone (way too high on the arm) which led me to believe the needle punctured the bursa sac & hit a nerve. The moment she did this, I immediately felt the pain I described above. The haphazard technique in which the injection was performed was incredibly negligent. 8 March: The soonest appointment I could get. PCM believed the issue to be muscle pain and believed it would resolve in 2-4 weeks. I was prescribed Flexeril and Celebrex. None of which has helped with pain, the Flexeril just puts me to sleep. I am unable to lift more than 5lbs with that arm and do simple things like put on deodorant/T-shirts, etc. without extraordinary pain (as in a more than a 7).  The PCM recommended a nerve test if there was no improvement in 2 weeks.  I believe this is definitely needed, in addition to a review of other medications that can help me with my pain during the day.  22 March: I called with appointment line as my pain is unbearable during the day. I was told the earliest date they had for an in-person would be 1 April. I wrote the PCM via my insurance asking if a nerve study could be done at that time and was told that I need to speak with my provider about that...Is that not what my insurance is meant to do? Due to the pain, I went to the ER and was prescribed an oral steroid and lidocaine patches and told it will take 2-4 months to heal. The 7-day steroids have done nothing for me, but the lidocaine patches are very helpful for pain and help me get me to sleep at night. Unfortunately, I can only use them every 12 hours, so I save them for nighttime.  1 April: PCM at suggested a steroid injection at the end April to help with physical therapy, which she just put in a referral for today (1 April). I asked if she could give it to me now if it helps but she wants to wait to see what the nerve study comes back and says, a referral for the nerve study was put in on 1 April, even though I requested it 22 March. 12/26/1992d I asked the PCM when I could expect the study and she has no idea when the nerve study will take place, but guestimates the end of April as that is when she wants to do the steroid shot. After speaking with neurology, there is no referral in for my test and referral management did not answer their phone when I tried to contact them. I visited info desk, they gave me four numbers for patient advocacy, referral mgmt. and neurology. One is an incorrect number and three of them are operable and, but no one picks up and the system states, "The mailbox you have reached cannot accept messages". The shirt gave me a number as well, but it provides the same mailbox message. I finally located the number/email for the patient advocacy on 1 April and informed them I am having an issue with care. As of 7 April, no one has called back.  6 April: Referral for a nerve consult (not test) was put in on 1 April, however no one acted on it. So, I physically went to referral management to see where it was sitting. Neurology had it, but the referral office did not have a number for them, only the consult and appointment line. After locating that office, myself, I was told a consult appointment would happen 30 April at the soonest. I stated that it was unacceptable to wait that long, given my track record of pain and I asked for the number to patient advocacy but was told they do not have it. I called referral management to get an external clinic to provide the test but received the following: ?The mailbox you have reached cannot accept messages.? I then tried the help desk, who gave me the number for the Facility. I was not able to catch the name, but I gave her the summary of my issues. I was returned a call by staff at referral management who said he will work with Agency to get my referral off-base since 30 April is far too long given my level of pain. There is a ?30-day access of care? standard but since I have been trying to receive this care since 22 March that 30 days is exceeded.  7 April: Went back to the ER due to the pain and was prescribed Cymbalta, which I only took for two weeks and then weaned off due to heavy depression.  12 April: EMG test at facility was performed. Test was excruciating, Dr. told me some people go to sleep because they have to lay there for so long (45min) Findings were abnormal but still listed as ?normal?. No comparison test was performed on my right arm to confirm a difference. Also, the test was performed the entire time with a ring on my finger (left arm) which I found out later was not great for accurate results. I was told to look forward to finding something with my MRI.  3 May: Went to with the Physical Therapist to get started as the PCM requested. The Dr. asked me to perform several exercises with a lacrosse ball. Then asked to put my arm above my head, which I could not do. He asked to force it up with my right arm and even though I tried it was not going to happen due to the incredible pain. Follow up visit scheduled 18 May. 7 May: Went to facility for an MRI ? process took 20min and was told the results would be avail in the next 3 business days.  15 May: Still waiting for an MRI review/phone call.