Age: 43.0
Sex: M
Vaccine: HEP, TYP
Symptoms: Pain, Paraesthesia
Clinical narrative: Information has been received from a health professional concerning a 43 year old male who is healthy with benign prostatic hyperplasia and has an ampicillin allergy who on 28-Jan-2005 was vaccinated IM in the left deltoid with a first dose of hepatitis B virus vaccine rHBsAg (yeast) (lot #647274/0426P). Concomitant therapy the same day included a first dose IM in the left deltoid of typhoid vaccine (Typhim VI) (lot X0481-2). There was no illness at the time of vaccination. It was reported that on 15-Feb-2005 the patient experienced pain in his right arm and shoulder. He also had weakness and numbness in his right thumb. He was treated with ibuprofen (MORTIN) and had EMG, nerve conduction, MRI and X ray of the neck done (results not provided). He was diagnosed with brachial plexitis. It was reported that the patient is not recovered. No product quality complaint was involved. Follow up information indicated that the EMG was done in April or May, but results will not be available until the end of July 2005. Additional follow up information from a health professional indicated that on 22-Feb-2005 the patient reported to a health unit with a 5 day history of right shoulder pain with finger tingling and numbness for one day. It was reported that this was noted on the day after he recalls a sitting in a meeting where his head was turned sharply to the right for several hours. He noted discomfort in the area of the right shoulder that could radiate to the upper arm. The pain was deep and could occur fairly unpredictably and sometimes be severe. He reported that it could make it hard to position comfortably in bed and could awaken him from sleep. He generally found that he was more comfortable if he elevated the arm. Several days after the onset of the pain he noted numbness of the tip of the right thumb with tingling and decreased cutaneous sensibility. He visited his primary physician who prescribed ibuprofen and topical heat. This did not make much of a difference. He then switched to ice, which he thought was more helpful. With chiropractic treatment his pain disappeared, though the numbness of the thumb persisted. He was referred to a neurologist. He saw the neurologist on 20-Apr-2005. It was noted that five days prior to his neurology visit he had a recurrence in his shoulder discomfort the day after he played basketball. An MRI was done which showed probable right C5 radiculopathy. An EMG was scheduled. The patient returned to the neurologist on 10-May-2005. He reported that he continued to find that when he advances activities he feels a setback with increased shoulder area discomfort. He has not noted a clear relationship to neck position. His exams continued to show a slight reflex asymmetry with the biceps and supinator reflexes on the right being a little less brisk than on the left and there was slight weakness of the right deltoid and possibly the biceps as well as a slight weakness of the right wrist extension that was not noted at the first exam. The EMG results revealed changes consistent with bilateral brachial plexopathies. It would appear most likely at this point that his clinical presentation was related to an inflammatory brachial plexitis rather than to a cervical root compression syndrome and this probably goes along with the fact that he did not think that treatment directed at his neck made much of a difference. It was reported that the recovery is ongoing. Additional follow up information was received that indicates the pain has resolved, but the numbness to the right thumb persists per the patient. All labs done including CBC,BMP, Liver enzymes, UA, Lyme disease RA factor and ANA were negative. The recovery is ongoing.