Age: 73.0
Sex: M
Vaccine: FLUX, FLUX, FLUX, FLUX, FLUX
Symptoms: Injection site nodule, Injection site pain, Joint range of motion decreased, Muscular weakness, Reflex test normal
Clinical narrative: This case was reported in a literature article and described the occurrence of axillary nerve injury in a 73-year-old male subject who was vaccinated with Influenza vaccine (unspecified) (manufacturer unspecified). The subject was right-handed and he did not report any preceding infectious illness, recent travels or contact with sick people. He had not seen a doctor for the previous 15 years not had had any regular screenings performed, but had received an influenza vaccine every year. No further information regarding the subject's medical, family history or concurrent medication has been provided. On an unspecified date, the subject received a dose of Influenza vaccine (unspecified) (left deltoid). Immediately after vaccination with Influenza vaccine (unspecified), the subject experienced severe injection site pain and felt like he had a "knot" in his shoulder. He never developed a rash at injection site but about 5 weeks after vaccination, he was not able to abduct his left arm. There was no other specific trauma or other history of recent injections to his shoulder. On clinical examination, the subject identified the midpoint of his left deltoid insertion as the painful area, which was slightly tender on palpation. There was notable atrophy of the left deltoid muscle with sensory loss on its lower half and he was unable to abduct his left arm. The subject had active range of motion for the first 10 degrees of shoulder abduction, but could not abduct beyond that. He scored a 2 on the Manual Muscle Test (MMT) of the deltoid, indicating poor function (25%). Passive flexion of the shoulder was normal. Flexion and extension of the forearm and rotary movement of the shoulder were normal. Deep tendon reflexes for his bilateral biceps brachii, brachioradialis and triceps were all normal and symmetrical (2+ grade). His other extremities were unaffected and he had no neck or radicular pain or other symptoms. The only other abnormal finding was elevated blood pressure. The subject declined to undergo further diagnostic testing because he was not an insurance beneficiary. The diagnosis of injection-induced traumatic axillary nerve injury was made based on the reported site of injection, medical history and clinical examination. This case was assessed as medically serious by GSK. Treatment was symptomatical and included analgesics and occupational therapy, including passive and active range of motion exercises. On follow-up, his deltoid muscle showed slight improvement in contraction, sensation, atrophy and pain after one month. His therapist reported a greatly improved flexion and that he was able to achieve 120 degrees of active left shoulder flexion in a seated position with a MMT score of 4, indicating good function (75%) 6 weeks after the occupational therapy started. The author's conclusion stated that while most adult vaccinations are administered intramuscularly in the deltoid and are generally safe, rare complications, such as nerve injury, may occur more frequently in the future as vaccinations are promoted. Practitioners should be aware of reporting systems, such as VAERS, so that ongoing standardization and quality control of vaccinations can occur. Nerve injury by IM injection is a serious and preventable complication that occurs worldwide and is likely to become more frequent with increased use of IM vaccinations. To address this potential problem, personnel who administer vaccinations should receive competency-based training and education. Alternative routes of administration may be considered to lessen risk.