Age: 35.0
Sex: F
Vaccine: TDAP
Symptoms: Loss of personal independence in daily activities, Muscle tightness, Myofascial pain syndrome, Pain, Pain in extremity
Clinical narrative: Pregnancy in 2018 resulted in live birth.  Received Tdap shot during that pregnancy with no adverse reactions. For this  current pregnancy, due date is 11/11/2020.   On September 2, 2020, I received the Tdap Vaccine given at my 30 week prenatal visit. CMA administered vaccine. Discussed receiving the shot in the dominant arm as using the arm could help decrease discomfort/pain due to vaccine. Shot was given in upper right deltoid. I remember thinking the shot was administered high compared to any IM shots received before.  Within 2-3 hours, there was general soreness noted in upper extremity around injection site. Pain level 2-3 out of 10.  By the evening, the pain had increased significantly with pain radiating deep within shoulder. I remember describing the pain to my family as though my shoulder was ?out of socket?. Couldn?t lean/sleep on right side that night or perform many activities of daily living due to pain when reaching across my body. Pain 6-7 out of 10.  By the next day,  the pain continued to increase.  Pain radiated in upper shoulder/deltoid area. Continued to be unable to sleep on my right side (making it extremely difficult to sleep at all as pregnancy makes me unable to sleep on back or stomach), take off my bra, reach overhead, wrap towel around myself, put my daughter in her car seat. At rest, pain averaged 6-7 out of 10. When moving arm, especially at end range, pain was 8 out of 10. Continued to wait it out as I was told pain/discomfort could last for a couple days.  On 9/8 I reached out to Dr. as the pain had continued and felt "wrong." Doctor recommended scheduling with primary care doctor or going to urgent care as the pain should have been decreasing by that time.  Also prescribed Tylenol. Scheduled appointment with primary care physician on 9/15 and began taking Tylenol for pain management with very little change in pain levels. Warm showers would provide temporary relief. Discontinued Tylenol due to little to no change in pain levels. Night time was the worst as the pain made it difficult to sleep because of pain/ache/burning sensation in affected right shoulder. And I feel uncomfortable taking medication during pregnancy when it isn?t making a difference. Over the next few days, pain began to subside and I was able to complete self-care tasks independently again, but still with pain. Though continued to have difficulty picking up my toddler and sleeping. Pain 2 out of 10. 5 out of 10 if slept on. Would wake myself up at night from pain of lying on right arm.  09/11/2020 was a ROUGH night. Could not get rid of ache, keeping me up a majority of the night.   On 09/15/2020, I went to see primary physician. Physician states she believes pain is due to poor administration of vaccine, placement ?too high?. And has resulted in acute myofascial pain (per physician note). During appointment, doctor reports that her diagnosis is inflammation secondary to incorrect placement of injection which is causing impingement of nerve, explaining the pain experienced at end range of certain movements. Physician performed basic ROM with me, abduction/adduction and external/internal rotation. Only applied weight/pressure on front ROM. Did not perform any functional assessments. I verbalized pain at end ranges of external rotation and overhead movements. Physician reports that she expects the issue to resolve within weeks/a month or so. Advised ice and Tylenol for pain management. When I asked about testing/radiology of any kind, she had no recommendations at this time. Physician states that ultrasound would not show any symptoms. Doctor advises to continue to keep her and my OB doctors in loop if pain continues.  By 09/16/2020, pain was back to 2 out of 10.  On 09/17/2020 had 32 week prenatal visit with Dr. Discussed pain since receiving tdap shot at 30 week visit. Doctor extremely apologetic but also unable to recommend any other forms of medication for pain relief at this time due to pregnant state. Advised to continue to follow up at subsequent appointments if pain continues. Another night of aching throughout the right arm. The following morning, pain radiated into forearm and towards wrist. General aching 2/3 out of 10. Consistent ache/tension in shoulder throughout day. On 09/18/2020, I dropped a bottle of creamer, which busted on the floor, when right arm ?caught? and sharp pain surprised me. At rest, arm continues to feel heavy and as though it has been overused, even though I have been using it less. As of 09/20/2020, there?s a constant ache in my shoulder during the day ? continues to keep me awake at night.  As of today, 9/22, ache/pain in arm continues. Can perform more activities of daily living as compared to those first few days following the shot but cannot complete without pain.