Age: 28.0
Sex: M
Vaccine: PPV
Symptoms: Injection site cellulitis, Injection site erythema, Injection site induration, Injection site pain, Injection site warmth
Clinical narrative: Patient received vaccine in primary care clinic on 3/23/2022  around 10:00am at routine wellness exam. Patient sent at 8:35am on 3/25/2022 correspondence  stating, "Hi Dr.  I just wanted to check to make sure the side effects I started experience on Thursday morning after getting the Pneumonia booster on Wednesday are normal. I started feeling very lethargic and had sharp pain at the site of the injection starting Thursday morning, and by the evening I very achey all over, running a fever and experience bad headaches. Those systems persisted through the night and I?ve woken up this morning (Friday) feeling just as bad. Is this a normal reaction or should I be concerned? If normal, how long does it usually last? Thank you" Patient was informed by Dr. at 11:32am on 3/25/2022: "Hi - not normal but it can happen rarely.  It would be expected to last just a day or two.  It might be worth getting a covid test just to be sure.  Otherwise tylenol or ibuprofen as needed.  You can apply heat to the injection site. Let us know if not resolving in next couple of days. " Over the weekend when the electronic messaging is not monitored and patients are advised to call for emergent issues, at 10:59pm on 3/26/22 patient wrote: "Hi Dr.,  Reaching out again as things have not improved and got much worse yesterday. My temp  was around 101 all day yesterday until around 6pm, when it spiked to 104 and I got extremely dizzy. At that point I went to the ER. When they were doing intake, my blood pressure dropped to 60/20. They got me laying flat and on an IV quickly, where my blood pressure returned to around 90/57. I was there from 6:30pm to 10pm, during which they gave me 2 liters of IV fluid, ran blood test, tested for Covid and flu. Covid and flu test came back negative, and all blood test were normal. Up through that point, my symptoms had still just been constant headaches, strong pain at the site of injection and persistent high fever. Because the injection site didn?t show any other signs of reaction, the doctor said it must be something viral and told me to just alternate ibuprofen and Tylenol. When I left hospital, temp was steady around 98 and blood pressure was 100/60. After I got home, weirdly injection site started developing faint redness. I took Tylenol and slept most of the night with some on and off fever sweats. Today I have 1000mg Tylenol every 5-6 hrs, and 600mg ibuprofen twice, 8 hrs apart. My temp has been in the high 99s most of the day, with a spike to 100.8 at 5pm and then another spike to 101 at 10 pm. Both times occurred around 5 hours after Tylenol as it seemed to wear off. Headaches have also persisted. Along with that, the red patch on my arm has grown considerably in size, gotten stiff to the touch and is constantly extremely hot to the touch. Even with all the pain meds, I?ve had a throbbing and sometimes stinging pain. With how my arm has developed, it seems even more likely it?s a reaction to the vaccine and continues to get worse after 3 nights and 2 full days of headache and fever. Do I need an antibiotic?."  Patient send an additional message on 3/27/2022 at 12:47pm "Sorry to keep adding messages, but want to update you on the latest. The red area on my arm was even larger when I woke up this morning (Sunday) so I went to an urgent care clinic. They determined it was cellulites, marked off the area and prescribed a 7 day dose of Cephalexin. They directed me to have a follow up visit with you tomorrow or Tuesday, and if I?m I?m unable to get in to see you , then to just come back and see them on Tuesday. I will call your office first thing tomorrow to see if a visit is possible, but I?m guessing you are all booked up."  Patient was seen at Emergency Department on 3/25/22 and again on 3/27/2022. Patient was seen today, 3/30/2022 in follow-up. He is currently stable and improving.