Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Erythema, Grip strength decreased, Hyperaesthesia, Hypoaesthesia, Hypoaesthesia oral
Clinical narrative: 1/11/2021: Within 40 minutes of receiving 2nd dose Pfizer vaccine, began having tingling bilateral arms proximal & distal.  Following day, developed a temperature to 102F which remained x4 days.  Since this time, has had continued tingling of the arms & low grade temperature (99F) & has begun having weakness of her upper extremities only with hypersensitivity to heat, as well as touch, but interestingly having decreased sensation to touch of her fingers, feeling as though she wears gloves, with no weakness anywhere else on her body.  She has also beginning to develop a sense of decrease cognition.  She has been seen by Neurology who felt this was a neurologic hypersensitivity reaction. Initially when she began having complaints following injections/day 1, she was given Benadryl with no improvement beyond causing her to sleep.  Since this time she has also been placed on prednisone with no interval improvement.  Relates no cutaneous lesions beyond mottling of her arms/no frank urticaria dermatitis etc., and has had no GI complaints or cardiovascular sequela.  4/19/21: This 60 y.o., female is referred by MD for evaluation of bilateral hand pain, weakness and numbness starting shortly after the 2nd dose of her COVID vaccine (5 her). The patient has generally been in excellent health.  On Monday, January 11th at 9:20 a.m. she received the 2nd dose of COVID vaccine  (Pfizer), in the left deltoid.  She had no immediate reaction but while driving about 45 min later developed numbness and tingling bilaterally in her face, lips, tongue and hands.  She awakened at about 3:00 a.m. with fever of 102, no abnormal sensations in her face but pain, redness and sensitivity in both hands. Systemic symptoms resolved in several days. Hand symptoms have continued to date.  Pain can range as high as 8/10.  She has marked sensitivity such that if she or someone else touches her hands it is extremely painful.  She sleeps with opera gloves to protect them.  She has not had neck pain but has developed grip weakness and has to use 2 hands to hold a cup of coffee.   She has never had adverse reactions to vaccines in the past.  She has had no immunologic disorders.  She initially saw Dr. who tried a short course of steroids without benefit.  She took gabapentin 200 mg followed by 100 and slept for hours without a change in the pain. NSAIDs have been ineffective.  No other medications have been tried.  She has had nothing to suggest a symptomatic COVID infection.  4/23/21: The patient continues to have bilateral hand sensitivity and temperature lability.  The EMG showed diffusely slow sensory conductions, consistent with the non correctable low temperature of her hands.  Motor conductions were notable for slowing in the right median motor with drop in amplitude proximally but with waveforms that did not suggest conduction block.  All motor terminal latencies and F response latencies were normal.  Overall the study is probably normal within technical limitations but if necessary should be repeated in about a month with her hands warmer.  The nortriptyline was just approved yesterday and the blood tests 2 days ago.  She will start the nortriptyline over the weekend and let me know if it is tolerable or effective.  She will get the blood work done early next week and I will review the results with her. HISTORY:  This patient with bilateral hand dysesthesias and temperature lability following COVID vaccination comes in for neurophysiologic testing.  Notably the nortriptyline was just approved and she has not yet started taking it.  Similar the blood test were just approved 2 days ago and she will have them drawn next week.  Her symptoms have not changed since he was here last.