Age: 64.0
Sex: M
Vaccine: PPV, VARCEL
Symptoms: Injection site pain, Joint stiffness, Lethargy, Malaise, Muscle spasms
Clinical narrative: 64 year old male retired presents with severe impacting adverse events following his 10 Aug 2012 immunizations with the pneumococcal and zoster vaccines. Presents for a filing a VAERS form and evaluation of continued symptoms to include generalized pain (myalgias, muscle spasms primarily in lower extremities, some joint stiffness and soreness without redness, swelling/effusions). Patient was feeling well on Friday with significant improvements in walking and functional abilities now over 3 months post Left hip replacement. Received his zoster vaccine (Merck, Lot 0068AE, 0.65 ml in his right arm SQ although route is not recorded in record), PNEUMOVAX 23 (Merck, lot 1418AA, 0.5 ml SQ. Location of injections were within less than 1.5 cm distance of each other. Within hours, he developed SEVERE 8-9/10 pain localized in his right upper arm extending to the elbow with redness that progressed over the next 24 hours to over 12 cm (5x6 inches), hard induration and extreme tenderness over the tendon insertions into the elbow. The first night he had hot cold chills, diaphoresis, (temp not taken) and progressively worsening generalized myalgias and arthralgias. Applied 1% hydrocortisone to shot site on Saturday afternoon but symptoms continued and by Sunday the generalized severe flu-like symptoms had worsened interfering with sleep duration and quality. Also had new onset severe spasms particularly in the right ("good") leg with knotting and some relief with deep tissue massage techniques. Difficulty walking and lethargic with only minimal improvement on Monday AM. Sleep interrupted again despite use of AMBIEN 5 mg along with regular medications of acetaminophen (2000 mg distributed 500 q 6), tramadol 50 mg 2X per day with TYLENOL, SOMA 325 mg Q 6 hours, ASA 325 mg enteric coated at night with niacin 500 mg, CELEBREX 200 mg in AM (no new medications), plus omega 3 fish oil and glucosamine chondroitin sulfate. Prior to this episode had significantly improved walking ability, not needing walker again to support. Patient is atopic and has tolerated annual flu vaccine recently except several years ago had a more severe reaction to 2009 H1N1 vaccine but NOT as severe as this. Systemic symptoms. General overall feeling is unknown and previously well. Generalized pain constantly, feeling tired (fatigue), feeling poorly (malaise), fever with sudden onset, chills recur, and night sweats. Neck pain and neck muscle tightness. Hand pain, stiffness of the hand, muscle cramps in the hands, wrist joint pain, stiffness of the wrist joint, pain in both arms, shoulder symptoms, back symptoms, pain in the thigh, thigh muscle cramps occurring at night, muscle tightness of the thigh, leg pain, foot stiffness, pain in the distal extremities, and pain in both arms and legs. Skin lesion: polygonal, on the right upper arm, timing, painful, developed rapidly, spreading rapidly, and enlarging. No eye symptoms. No otolaryngeal symptoms. No breast symptoms. No cardiovascular symptoms. No pulmonary symptoms. No gastrointestinal symptoms. No genitourinary symptoms. No endocrine symptoms. No hematologic symptoms. SEVERE LARGE LOCAL WITH IMPACT ON ARM FUNCTION, SPASM Size > 20 cm by 15 cm hard induration, spasms of arm with radicular pain