Age: 58.0
Sex: M
Vaccine: DT, FLU3
Symptoms: Asthenia, Injection site nodule, Injection site pain, Injection site reaction, Neuritis
Clinical narrative: Initial report received on 09/jan/2006 from a physician. A 58 year-old female patient with no pre-existing medical history received an intramuscular injection of Fluzone SV 2005-2006, manufacturer Sanofi Pasteur, lot number U1794AA, on 10/Nov/2005.  Site of administration was not reported.  On the same day, she developed tendonitis and neuritis of the left shoulder.  Physical exam of the shoulder revealed a decreased range of motion, decreased extension and 4/5 strength of the left upper extremity.  Other medication were none and there were no illnesses at the time of vaccination.  At the time of this report, the patient had not recovered although the reporter indicated that the patient is in the process of recovering.  Follow-up information received on 22/Feb/2006 Fluzone was administered in the left upper arm (deltoid). Per reporting physician (who is from patient's plan) she saw the patient on 02/Jan/2006.  The patient related a history of soreness and a knot which developed approximately 1 inch x 0.5 inches, in the general area of where the flu shot was given in the left upper arm followed by achiness, decreased range of motion, decreased strength in the upper extremity.  Currently the arm is not swollen all the time, but it aches.  The patient says it is slowly getting better,  and previously it really hurt when she got the flu shot.  On physical examination, there is decreased extension and decreased range of motion of the left upper extremity between 90 and 180 degrees.  Reporting physicians assessment:  Neuritis or tendonitis, adverse reaction to flu vaccine.   Treatment included two physical therapy  sessions, Motrin as needed.  No laboratory or diagnostics were performed.  The tendonitis was limited to the left shoulder. The patient's condition was deemed to be not work related and she requested to continue her full duty.  The physician will see her again in 7 to 14 days.  On 04/Jan/2006 the patient's work place spoke with the patient.  She will be following up with her own physician and has scheduled own PT as this is not a work related issue.  The patient cancelled her appointment with the reporting physician which was scheduled for 17/Jan/2006. Follow-up information received on 23/Mar/2006.  The case was reviewed and no additional information was available.  Follow-up information received on 20/Jun/2006 from a health care professional.  The reporter contacted the patient who stated that she experiences severe pain with certain arm movements several times per week.  When the left arm is elevated to shoulder height, she has pain at the injection site (4-5/10 on pain scale).  When she lowers the arm, the pain dissipates.  She still notices the left sided weakness, but has adapted to use both hands for a surer grip.  Per the reporter, she had not had any further evaluation or treatment related to this incident.  Follow-up information received on 24/Jul/2006 from a health care professional.  The patient had received physical therapy treatments.  Per the reporter, the pain in the left arm continues.  At the time of this report, the patient had not been evaluated by a neurologist or private physician although she "plans to seek advice from primary care physician."