Age: 56.0
Sex: F
Vaccine: TTOX
Symptoms: Erythema, Facial palsy, Flushing, Injection site warmth, Musculoskeletal stiffness
Clinical narrative: Right upper arm between elbow and shoulder was swollen, red and feverish the morning after the shot. I had been told to expect a sore arm so I thought this was normal reaction. On 11/3/99, I went back to the doctor for my sore arm and he gave me dicloxacillin prescription and instructed me to also pick up Benadryl. My arm proceeded to turn dark and blue and eventually the swelling subsided. 7/5/00 On this day I began having pain in my right shoulder down my right arm, in my right face, jaw and neck area. This occurred without any previous injury. On 7/11/00 I went to doctor for these symptoms. Initially he sent me to a neurosurgeon who read my MRI study. This neurosurgeon then ordered physical therapy and epidural treatments. Doctor also had prescribed pain medications for the severe pain I continued to experience in my jaw radiating through my neck down my right arm. On 9/11/00, another doctor took over my care and I continued with the physical therapy and epidural without relief from my pain. I also had acupuncture to my shoulder without relief from pain. 3/15/01 Doctor who was performing the epidural stated he felt my problem was an ? and not a neck problem. Therefore he initiated tuggerpoint injections. 4/10/01 Doctor referred me to another doctor (orthopedic surgeon) who ordered therapy for a frozen shoulder after I had an MRI. On 8/21/01 I went for a second opinion. The doctor administered lidocaine/cortisone injection into bursae. Doctor sent me back to the other doctor. Doctor then manipulated my shoulder on 9/5/01. Throughout these consultations I had continued with physical therapy on my neck and shoulder along with the tugger point injections. In 12/6/01 I seen a doctor who felt my problem was not my neck but my arm so I was sent back to the other doctor. However, this doctor disagreed and now states your wing bone is rubbing on your rib and he administered another cortisone injection. Doctor states therapy is making your muscles sore and I never noted in my records on previous appointments that your shoulder needed manipulation. On 1/15/02 doctor states you never had a neck problem; you have bursitis in your wing bone. So the doctor again gave me a cortisone injection in the wing. On 3/5/02 doctor repeated an MRI on my shoulder and gave me another cortisone injection. This injection was repeated 4/24/02. On 5/23/02 doctor performed a partial bursae removal and bone spur removal. I also continued physical therapy as ordered by doctor. Due to persistent pain, I went back to the other doctor who stated the neck pain will go away when your arm gets better. By 8/13/02, doctor was still confused why my face, jaw, neck and shoulder pain persists despite his treatment. On 8/27/02 I noticed an increased redness and warmth to the whole right side of my head and face. I went to the ER where they took blood work and performed shoulder and jaw x-rays. I was given a pain shot and antibiotic, plus a prescription for pain pills, although there was no conclusive diagnosis. 8/30/02 Due to no relief and persistent problems, doctor referred me to another doctor. This doctor took more films and also could not pinpoint what caused the persistent problem. On 9/4/02 I had a EMG performed which showed that the neck was not causing the radiating pain. On 9/4/02 doctor had more x-rays done and referred me to yet another doctor. Doctor had another MRI done and performed neurological testing also. Doctor did not find a need for me to have surgery either. 9/22/02 Doctor gave me prescription for a medrol dose pack. I have continued with physical therapy and epidural as prescribed. On 9/24/03 doctor had lab work done and found positive ANA titer. Doctor then sent me to another doctor (a rheumatoid arthritis  specialist). He did not find any abnormal conclusion. On 10/4/02 I went back to the doctor, who reviewed my film and tests, then stated that your neck C5-C6 is not causing the right facial paralysis, swelling and flushing. He did not recommend neck surgery as he felt my neck was not causing these persistent problems. Doctor referred me to another doctor who was a surgeon specializing in head and neck disorders. I then repeated MRI's which localized skull based to clavicle area to rule out a parotid lesion. He claimed the lesion was seen but did state "I see the swelling, redness and face flushing. He also sated "you know by now this is not a normal situation and you need to pursue this until a doctor finds the problem. On 10/22/02 I went back to the doctor who again states he cannot believe that no one can find what is wrong. At this time, i was given a prescription for Amytriptyline. I am still doing physical therapy and receiving cortisone injections as prescribed by the doctors. On 1/17/03 my physical therapist tried water therapy due to continued rigidity of my neck. I had 2 weeks of water treatment followed by stretching and pulling of the neck for a total of 22 visits without any improvement in my pain level. Then therapist states I have not seen a neck this stiff and it is bone that was not allowing any movement; not muscles. On 2/18/03 I seen the doctor. His conclusion was that my neck is too stiff and tight and will now allow the jaw to open correctly. Again, I received cortisone injection plus he gave me a Neurontin prescription. Doctor states this makes no sense why you continue to have these problems. 4/22/03 and 6/6/03, I received cortisone injections again. My last physical therapy was 3/28/03 and I continue on Amytriptyline, Neurontin, Celebrex, and Tylenol prescriptions for persistent pain. 60-day follow up on 02/04/04: "Pt has not recovered from adverse events. Still in treatment-arm, neck, jaw, face, and shoulder are still being treated and have resulted in permanent disability."