Age: 57.0
Sex: F
Vaccine: TD
Symptoms: Pain in extremity, Paraesthesia, Synovitis, Ultrasound Doppler normal
Clinical narrative: A 57-year-old female patient with a medical history of allergy to "PCN", beta blockers, SELDANE and "ANETIME", and who had a cut on her left leg from "furniture", had received a dose of TET TOX ADS USP, lot number 26388A, in the right arm on 18 October 2006. At an unspecified amount of time later, the patient's right hand was numb and her right hand and arm were swollen. She was seen in the emergency room and treated with PREDNISONE and antihistamines. The patient was evaluated by a surgeon and X-rays were sent to a neurologist. An ultrasound of the right arm and nerve conduction tests were completed. The results were not provided. Reportedly, there is "nerve damage". At the time of this report, the patient had not recovered. Follow-up information received on 16 April 2007 from a health care professional. It was reported that the patient received DECAVAC, lot number U1879BA, administered intramuscularly in the right deltoid on 18 October 2006 at 11:45 AM following a laceration to the left lower leg. The onset of the adverse events was later that same evening. On 19 October 2006 the patient was seen for a follow-up visit, where it was noted that she had swelling of the right upper arm and cellulitis "was mentioned". She was treated with ROCEPHIN 1gm, administered intramuscularly in the buttock, and was given a prescription for oral antibiotics. On 21 October 2006 the patient was seen in an emergency room. She had edema to her right upper extremity and secondary paraesthesia. She was advised to apply ice to the area and elevate the extremity, as well as follow-up with her primary care physician. A doppler study of the right upper extremity on an unspecified date was reported to be normal. No new information was provided regarding the patient's recovery status. Follow-up information was received from a health professional on 21 August 2007, which included an orthopedic consult dated 10 November 2006. Additional medical history included arthritis of the hands, a whiplash injury (2004), lumbar spine surgery, and thumb surgery. The patient had undergone nerve conduction studies "approximately 2 years ago" which showed mild carpal tunnel syndrome; testing for rheumatoid arthritis had been negative. She had also, prior to vaccination, been seen by several hand surgeons and two rheumatologists. She stated that she was experiencing numbness in the entire right hand, with a dull, deep ache and pain at the base of the thumb (which had previously been operated on). She stated that her symptoms were "severe" and radiated throughout the entire arm. Physical examination of the hands revealed swelling at all metocarpophalangeal joints, wrists, distal radioulnar joint, and base of thumb; synovitis; "grind test" on the right; and a zig zag thumb collapse bilaterally. Review of bilaterally hand x-rays were remarkable for soft tissue swelling around the MP joints and significant arthritis at the base of the right thumb. C-spine x-rays showed very severe, multilevel changes from C3 through C7. It was the impression of the orthopedic consultant that the patient had "long-standing nerve compression of some type, with significant thenar and intrinsic wasting. It may be perhaps muscle disease or some other. It may have been exacerbated by significant swelling in the right upper extremity after her immune response to the tetanus shot". It was recommended that the patient undergo additional nerve testing, and begin taking methotrexate as had been previously recommended. Diagnosis included "significant nerve compression, bilateral upper extremities, more symptomatic on the right" and "inflammatory arthropathy".