Age: 35.0
Sex: F
Vaccine: FLU3
Symptoms: Pain, X-ray normal
Clinical narrative: This medically confirmed health authority report (initial receipt 02-Dec-2014) concerns a 35-year old female patient who had no current illness. The patient had medical history of peanuts allergy and eczema. Her concomitant medication included triamcinolone acetonide cream 0.1% (for eczema). On 02-Sep-2014, the patient received intramuscular AFLURIA (batch number: T57606) in the left arm. The injection site was at 1 cm below the acromion. On 02-Sep-2014, the patient initially developed pain (level 4 or 5 out of 10) in shoulder joint when the arm was raised backward 30 degrees, raised sideways 180 degrees, raised forward 90 to 135 degrees or raised to the side 90 degrees (horizontal) and rotated forward with thumb pointing to ground. The injection site itself never had any redness or swelling. There was initially some soreness in about a quarter-sized spot around the injection site for the first three or four days. The deltoid muscle never became sore all over like it usually does. The injection looked like it was given too high to have hit much muscle, if any. On 04-Sep-2014, the patient thought that the initial injury started to get better, the pain started to decrease but the patient felt a bit of stiffness and tightness (which eventually started to decrease by 12-Sep-2014). At night, the patient developed 'an odd sensation as though the back of the head of the humerus was covered with something that wasn't normally there, like a plastic wrap'. This persisted for a couple of days. On 05-Sep-2014, the patient went to the orthopaedist, but the pain at that point was pretty minimal, probably at 1 of 10. The orthopaedist had never seen a shoulder injury from a vaccine before. Her shoulder injury appeared to be healing. The orthopaedist stated that the structures under the injection site like the tendons and bursa were tough so perhaps there was a good chance that the needle did not penetrate. On the same day, she had an x-ray but it did not show anything unusual. From 05-Sep-2014 to the 09-Sep-2014, the shoulder was about the same with not that much pain (1 out of 10), but the feeling of stiffness persisted. On 10-Sep-2014, the pain started to increase a bit and increased again on the next day (4 or 5 out of 10). The patient found a web page describing a physical exam for rotator cuff injuries and felt that he had all the described pain except when raising the arm horizontally to the side and pressing down on it (supraspinatus test). Some movements were consistently painful throughout the whole course of injury (not always to the same degrees, like raising her arm forward above 90 degrees through 135 degrees or sometimes higher, also when her arm was raised horizontally to the side and rotated forward to thumb pointing to the floor). Other types of pain seemed to come and go. The patient received ibuprofen (200 mg) when there was pain. Her shoulder sometimes started to hurt when raised sideways above 90 degrees too, though the description the patient found for tendonitis and bursitis mentioned relief in pain during this motion. On the first three days and on 09-Sep-2014, the patient had pain on moving the arm backward and various directions that seemed to come and go and disappeared she try to repeat a movement that caused pain. The patient felt like there was sore tendons on the front and back of the head of the humerus (the patient thought they could be the bicep tendon, the teres minor and infraspinatus). She took heat treatment that was more effective than ibuprofen. The condition of her shoulder had been fluctuating from day to day since 10-Sep-2014. At the time of reporting, the pain decreased over the last three days in a row. The outcome was reported as not recovered. Reporter comments: The health authority assessed the events as non-serious.