Age: 68.0
Sex: F
Vaccine: PPV, PPV
Symptoms: Malaise, Myalgia, Nerve conduction studies, Nuclear magnetic resonance imaging, Pain
Clinical narrative: November 30, 2007 received pneumonia vaccine: Co. Merck, Lot; 0070u/2/15-09.  Within a few hours noted a hard area sensitive to touch and some pain.  December 1, 2007 muscle pain began in arm, by evening the pain was very severe (8) particular at the biceps.  Upon inspection large red raised areas were noted.  The injection site was bright red, surrounded by a white halo which was surrounding by a red halo.  The two large reddened areas extended from injection site medially to inner aspect of arm, hot to touch and very painful, in particular the medial one.  I experienced chills, elevated temperature.  Applied ice, 20 min. about every 1.5 hrs. and took BENADRYL.  This gave some temp relieve.  December 2, spoke with the nurse, who recommended ADVIL, took ADVIL throughout the day, in all 3 tablets for pain.  December 3, saw physician.  She diagnosed cellulitis.  Prescribed antibiotic LEVAQUIN, qd for 10 days.  December 5, redness decreased, however pain began to radiate down the arm, particularly along the biceps, triceps to the medial aspect of the elbow and under the scapula to the spine.  December 6, I awoke with severe pain radiating all over the shoulder down to the hand.  Called MD and informed RN about changes in pain.  The arm felt as if it was a foreign appendage.  December 8, evening, suddenly extreme chills for over an hr. no temp. took 1 ADVIL and slowly began feeling a little better.  December 10 returned to MD, prescribed prednisone 60 mg, for 5 days.  Within an hour there was no more pain.  December 15 took last dose of prednisone.  December 16 pain returned, almost as severe as before, particularly over scapula and arm, at times very sharp stabbing pain in arm.  December 17 called MD informed RN of pain returning within in 25 hrs. after last dose of prednisone.  In pm joint pain and muscle pain began.  December 18, experienced elbow, knee, hip joint pain, muscles of legs, arms, back ached, I felt terrible, as if body was "disintegrating", extremely lethargic, unusually tired, and great difficulty concentrating at tasks.  December 19, felt somewhat better in am but continued to have muscle and joint pain, however less severe tired throughout day, no energy.  December 19 saw my regular Dr. who had conferred with the partner who had seen me during the last two visits.  Dr. ordered an Ultrasound to check for possible cysts or?  Prescribed prednisone 15 mg. for 3 days, followed by 10 mg. for 3 days, 5 mg. for 3 days, 2.5 mg. for 3 days.  Currently I am taking 5 mg.  The same pain has returned in the biceps since the decrease of the prednisone there is still a small reddened area of sensitive to mild pressure.  Dr. suggests that I developed a reaction to one of the additive in the vaccine.  As children we were immunized with live bacteria against TB.  I had a bad reaction resulting in fistulas at the injection site, took weeks to resolve.  February 13-08- Very little has changed concerning the pain since I wrote the above.  There may be one or two days a week when I have not much pain, and then there are days when I wake up with pain in the left arm and it is already a 4 or 5.  It can involved the total arm, beginning from the lateral aspect of the scapula.  Sharp, burning and stabbing pain is often present.  The burning like pain is the most unpleasant.  At times it feels as if the muscle like muscle cramps, particularly in the biceps, brachialis.  Slight pressure on the arm can cause great discomfort, pain.  There are days when the left hand feels warmer than the right.  The only time I ever had total sustained relief (no pain) happened when I was taken the prednisone.  An MRI was done February 1 and 5, 2008.  Since February 08, there has been little change in the pain, except I had a few days last week (March 1-5 less pain) but now it has returned and is more severe, ranging between 4-8.  The last three days I have had consistent pain between 5-8 or nine at times.  March 11-08 pain continues much as before. Nerve conduction study and muscle testing, results inconclusive, no damage noted.  Wait out pain??  May 5-08: By this time I have seen, an Immunologist, Infection Specialist, and a Neurologist at the clinic; an addition I have seen a physiatrist, had an MRI, a nerve and muscle study done, all results are negative.  The immunologist had extensive blood work done, titer etc. nothing showed any abnormality.  The immunologist and neurologist thought that it may be the medium in which the vaccine was immersed.  I am attaching an article of the antibiotic LEVAQUIN I was given without prescription, as they were samples from the doctors office.  Within days of the antibiotic the pain began, the doctor prescribed prednisone, you may look up that combination as well.  At the end of March the pain suddenly was gone but for a very distant, very light feeling of pressure.  Then last week the pain returned, same places, same severity.  I had moved some objects of some weight, but not beyond my capabilities.  I experience pain as I write this, just about any stress on the arm seems to have an impact and aggravated whatever is going on in my arm, and even total shoulder.  If you have any suggestion let me know.  I am not sure if I should have a bone check, but as I know the MRI showed nothing, "but for a 6-mm, well defined cyst-like lesion in the distal humeral metaphysic, and mild signal heterogeneity at the common extensor tendon origin.  Ultimately unremarkable", according to Dr.  Never has my right upper arm shown any of the same signs, my left arm still does not feel like my right since I received the vaccine.  Thank you for reading this.  Any reply would be appreciated.