Age: 62.0
Sex: F
Vaccine: RSV
Symptoms: Injection site pain, Injection site swelling, Joint noise, Mental disorder, Myalgia
Clinical narrative: Pt came to be seen for a skin infection and 2 vaccines. Pt states the provider was with her for over an hr at her visit, during which time she did treat her for a normal visit and give her a flu vaccine without incident. The provider, however, had never given an RSV vaccine and seemed overwhelmed and unprepared to give it. She repeatedly was reading the in-clinic reference card for the vaccine, looking up how to reconstitute it online, and ultimately pulled out the package insert in front of the patient to try to figure it out. When the provider was ready to give the vaccine, the patient was trying to be polite and patient, but was honestly very anxious and her gut was telling her to leave and not get it. However, she allowed staff to give her the vaccine which the patient states "immediately felt odd." It seemed like the provider was nervous and the needle may have gone in and out and then back in, prior to administration. When the vaccine was ultimately given, it immediately was a severe burning sensation and became red and swollen- much different than the flu vaccine.   As RSV is a new vaccine, the patient has never received it, so she gave it a few weeks but it was not improving. She went to see her PCP after ~3 weeks of ongoing symptoms, who encouraged her to continue to watch and wait. When it still did not improve, she was told to try icing the site, which she was already doing, and finally her PCP brought her back in for evaluation. At that time, the patient states the site was so hard and swollen that it felt like she had a softball under her skin. Her PCP gave her a round of PO steroids, which made her feel much better, "20 years younger." She was able to work on her farm and with her horses without any discomfort. However, after being off the steroids for ~7-10 days, the pain returned and was much more severe. She was having pain that "feels like she's being hit with a taser," keeps her awake at night and has brought her to tears. She suspects a nerve may be involved, because the pain will often shoot down her arm, just deep to the biceps muscles, and down into her elbow. She also will hear a crunching sound in her shoulder when she tries to rub the area, as well.   She has since been rx'd a second round of steroids from her PCP in the beginning of November, and was then referred to an orthopedist due to the persistence and severity of her symptoms. She saw the orthopedist this week and they completed xrays, but only saw some areas of arthritis. No MRI has been ordered at this time. They recommended a joint injection, but she asked if she could do another oral steroid instead, as she has seen issues in her horses following steroid joint injections.  Pt is unsure of her formal diagnosis from her PCP or the orthopedist, but she is willing to fax her progress notes to provide this information.   Pt. also states she has a palpable "dent" or concave area on her arm where the injection was given, and sometimes she can press this area to alleviate the shooting pain in her arm. She also reports that, as this has obviously been an ongoing issue since her visit in September, she is having mental health/depression from the chronic pain and the thought that she may be in this level of pain indefinitely.  She has done her own research and believes she has SIRVA from the RSV vaccine.