Age: 58.0
Sex: M
Vaccine: VARZOS
Symptoms: Blood creatine phosphokinase normal, Borrelia test negative, C-reactive protein increased, Full blood count normal, Headache
Clinical narrative: From 8/16/2018: General. Patient is a 58-year-old male here today with complaints of diffuse myalgias. History of presenting illness patient is a generally healthy 58-year-old fellow about 30 days ago he received his first of 2 SHINGRIX shots. He noted symptoms of nausea, malaise and headaches which continued for 2-3 days after getting his injection. Patient adds that since that time however he has developed slowly progressive issues of initially what started as pain in the muscles in the inner aspect of both thighs. This was symmetric. He has developed this in additional areas now including posteriorly in the neck. He has had no known symptoms of fever. He has also had some pain in the calf bilaterally. He cannot think of any activity which led to myalgias. His symptoms are considerably worse when he goes to a standing position and after he takes several strides his pain seems to get somewhat worse. This has not caused considerable limitations with activities. Review of systems. Patient denies any midline neck discomfort. He has noted no rashes elimination patterns have been normal. His appetite is intact. There are no other members in the home with similar symptoms. Past medical history the patient was an occasional smoker many years ago but has not smoked now for years. He describes her general health is good. He is not on any statin medications. He does have some issues with joint pain diffusely but this is reminiscent of that at all. He does not use excessive alcohol. He has had no known tick exposure recently. From 8/24/2018 note: Patient presents for recheck of myalgias, onset about a month ago, shortly after receiving the SHINGRIX vaccine. He was seen on 8/16 by my colleague and was started on doxycycline for possible Lyme disease, but reports that it has not made his symptoms any better.  He feels like the muscle pain has progressively gotten worse. He describes the sequence of events as receiving the vaccine and the following day he noticed some achiness and he felt "crummy, like I had the flu." 2 days after receiving the vaccine he had a fever up to 101° and night sweats for a couple of days. On day 4 or 5 following the vaccine, he developed muscle pain that first started in his hamstrings and then progressed to his lower back and up to his neck. He went to the chiropractor and had an adjustment, but that did not seem to help. He also went to the races and consumed a fair amount of alcohol (he estimates about 20 cans per day for 4 days); he reports that his muscles felt better when he was drinking alcohol and he thought that the pain had resolved, but after he got back home, the muscle pain returned. He has the most pain when he first gets up in the morning and starts moving around; it tends to get a little better through the day. Just in the last couple of days he has also noted some pain in his calves. He has not noted any pain in his joints, nor has he noted any weakness in his arms or legs. He describes the muscle pain as similar to when he was younger and did not really do much over the summer and then went back for football practice and how his muscles hurt afterward. He has not had any recurrence of fever or chills. He denies any shortness of breath, chest pain, pressure, abdominal pain, bowel or bladder issues, or numbness or tingling in his extremities. He has taken some acetaminophen, but that has not really helped very much. From 8/28/2018 note: Patient returns for recheck of myalgias. He estimates that he is 50% better compared to last week. He has been taking 1?2 tablets of the cyclobenzaprine 2 or 3 times per day and has taken the naproxen a couple of times, but had the medications confused and thought the naproxen was the medication that was going to make him drowsy, so he had not been taking it. He was wondering why he was so tired from having taken the cyclobenzaprine. He is still having morning stiffness but is now able to bend down and pick something off the floor. From 9/4/2018 phone note: Returned phone call; spoke with patient. He indicates that the muscle pain initially improved on the naproxen and cyclobenzaprine, but has not continued to improve. He is not having any joint pain, only the muscle pain. Will have him take a course of prednisone, 60 mg once daily times 3 days, then 40 mg once daily times 3 days, then 20 mg once daily times 3 days, then 10 mg once daily times 3 days. Prescription sent to pharmacy. We will plan to see him in follow-up around September 17 or 18. He should have just completed the course of prednisone by then. Requested that he contact the office by early to mid-next week if he has not noted any improvement. He verbalizes understanding.