Age: 46.0
Sex: M
Vaccine: HEP
Symptoms: Swelling
Clinical narrative: Information has been received from an RN concerning a 46 year old "very large" black male who on 5/22/00, 7/11/00 and 11/27/00 was vaccinated with the 3 dose series of Hep-B vaccine recombinant (yeast), all from the same lot (lot 630591/1735J). On 3/27/01, a titer was drawn which was negative for antibodies. The series was restarted and the pt was revaccinated on 4/4/01 with a booster dose of Hep-B (lot 630717/1047J). The nurse reported that she did not think that it was unusual for someone to complain of pain from an immunization. A 2nd booster dose of Hep-B (lot 636717/1592K) was given in the right arm on 5/24/01. At that time, the pt reported to the nurse that he was having pain, along with numbness and tingling in both arms and that he was experiencing symptoms on the 4/4/01 vaccination, but only reported the pain. On 6/12/01, the nurse called the employee health physician to report the pt's symptoms. The physician indicated that he would like another titer drawn and not to administer the 3rd dose of Hep-B vaccine, even though he did not feel that the symptoms were related to the series. On 6/21/01, the pt saw the physician and reported that he had pressure, soreness at the injection site in his left arm for the past 1 1/2 months which progressed to a burning in his fingers of the left arm and that the symptoms come and go. He also reported pain, tingling in his right hand and swelling of his fingers in his right hand. Furthermore, he indicated that the symptoms were worse in the mornings. The physician's assessment was carpel tunnel symptoms. The physician ordered night splints. On 7/5/01, the pt saw the physician again and reported that the symptoms were the same. On 8/23/01, the pt had another physician visit and he reported that he was wearing the hand splints at night, was on no medications and was not feeling any better. The physician's assessment was early carpel tunnel syndrome and he ordered an EMG. The pt was referred to a plastic surgeon that specializes in hand surgery, who reported that he did not think that the bilateral carpel tunnel syndrome was related to the vaccine. On 11/14/01, the pt was admitted to the hospital and had surgery on his right hand and on 12/12/01, he had surgery on his left hand. The pt returned to work from workers compensation on 1/28/02 to "light duty work". The pt works for a company who manufacturers candy. The nurse indicated that his job at the plant is not too repetitive in nature and that he sometimes had to lift heavy boxes. His current status is that he is on "light duty work" which does require him to do some repetitive movements with his hands. The nurse reported that they would need to look into moving him to another area of light duty to minimize the repetitive movements of his hands. The pt still complains of some numbness and tingling in both hands and is not progressing post surgery as other pts who have seen the same surgeon, however it is not as bad as it was in the past. The nurse indicated that she reported the event because it has been going on for such a long time, even though they do not think that it was caused by the hepatitis vaccine. Additional information has been requested. Follow up info received from a physician indicated that the pt did not want any more info released. No further info is available.