Sex: F
Vaccine: UNK
Symptoms: Pain in extremity, Periarthritis, Wrong technique in product usage process, X-ray limb abnormal
Clinical narrative: Osteomyelitis; loss of left arm mobility; decreased range of motion; pain in her left arm; Frozen shoulder; Parsonage-Turne syndrome; over penetration by the needle; over penetration by the needle during the intramuscular injection; This case was reported in a literature article and described the occurrence of osteomyelitis in a 15-year-old female patient who received HPV 16-18 (HPV 16-18) for prophylaxis.    On an unknown date, the patient received HPV 16-18 (intramuscular). On an unknown date, 11 days after receiving HPV 16-18, the patient experienced osteomyelitis (serious criteria GSK medically significant), immobile (serious criteria GSK medically significant), injected limb mobility decreased, pain in arm, frozen shoulder, parsonage-turner syndrome, needle injury and wrong injection technique. The patient was treated with steroids nos (Steroids), gabapentin and antibiotics nos (Antibiotic (Details Unknown)). On an unknown date, the outcome of the osteomyelitis, immobile, injected limb mobility decreased, pain in arm, frozen shoulder, parsonage-turner syndrome, needle injury and wrong injection technique were unknown.   The reporter considered the osteomyelitis, immobile, injected limb mobility decreased, pain in arm, frozen shoulder, parsonage-turner syndrome and needle injury to be related to HPV 16-18.  Additional details were reported as follows: This case was reported in a literature article and described the occurrence of osteomyelitis in a 15-year-old female patient, who was vaccinated with unspecified human papillomavirus vaccine (manufacturer unknown) for prophylaxis. The patient had no past medical history. No information on patient's medical history, family history, concurrent condition or concomitant medication was provided. On an unspecified date, the patient received intramuscular injection of unspecified human papillomavirus vaccine (dosage unknown; batch number not provided) in left arm. The age of vaccination was not provided but it could be 14 years or 15 years. On an unspecified date, 11 days after the vaccination, the patient developed severe pain in her left arm and decreased range of motion. Over the following month, the patient was treated with a short course of steroids for frozen shoulder and gabapentin for Parsonage-Turne syndrome. During the third visit to a specialist for severe pain and loss of left arm mobility, the patient was sent to the emergency department for further workup. An x-ray and magnetic resonance imaging of the left arm were suspicious for osteomyelitis. The diagnosis was confirmed by incision and drainage of the abscess and a bone biopsy. A 6-week course of antibiotic therapy was initiated after the biopsy results. The injury was attributed to over penetration by the needle during the intramuscular injection the patient had received in the previous month. The author commented and stated, "As the number of states allowing pharmacists to vaccinate patients of all ages grows, pharmacists must be prepared to safely provide vaccinations to patients of varying sizes. Assessing body habitus while balancing the constant responsibilities of a community pharmacy will be a challenge. Introduction of a guidance document with specific needle lengths based on weight, age, and sex can address potential errors before they occur."      Lab Comments: Lab test done on an unknown date. An x-ray and magnetic resonance imaging of the left arm were suspicious for osteomyelitis. The diagnosis was confirmed by incision and drainage of the abscess and a bone biopsy.