Age: 44.0
Sex: F
Vaccine: FLU3
Symptoms: Abdominal pain upper, Activities of daily living impaired, Allergy to vaccine, Anal fissure, Asthenia
Clinical narrative: Injection site soreness-worsened within 2 weeks.  Low grade fever for 2 weeks, fatigue, malaise, did not feel right-left arm pain 9 on 10 scale for weeks...see attached journal.  As of March 21 2008 arm still sore and weak.  November 14, 2007 Had annual flu shot.  Experienced injection site tenderness that evening and next day.  Nothing unusual.  Have received about 8 consecutive flu shots in the past.  Arm soreness progressively got worse over the next week and 1/2.  Peaked at 10 days.  Pain 9.5 on 10 scale.  Deltoid, bicep and tricep pain; deep ache, burning.  Adduction, abduction of arm in all planes difficult and very painful.  Supine position most uncomfortable; hard to get a nights sleep.  Simple things like driving, taking shirt off, reaching for something; very difficult and painful.  Ran low fever for two weeks.  Self/Home remedies: Tried ibuprofen, no relief.  Heat therapy; no relief (possibly worse).  Chiropractic visit; gentle range of motion; no relief.  Took old prescription Flexeril one night to help pain and sleep; no pain relief but I slept.  Hot bath; no relief.  Analgesic rub (Biofreeze); no relief.  Saw massage therapist on Dec 5; relief during visit only.  November 26: Went back to doctor's office on Monday, November 26 as a walk-in asking to see a doctor about an adverse reaction I was having.  Saw Dr.  He read the insert on the vaccine package about side effects and questioned whether I could have brachial plexus neuropathy.  Recommended I have blood work done at hospital to check protein levels and scheduled an appointment for Dec. 7, 2007 (when results would be in 10-14 days).  He told me to keep the arm moving so it wouldn't seize up.  Have been doing light workout for past two weeks to keep muscles moving and to avoid atrophy.  Chest press, upright row, deltoid raises (very difficult), low row, tricep and bicep exercises.  Week of December 1, 2007 Pain is reduced to 5 or 6 on the scale.  Simple movements still painful and awkward.  Night time seems worse.  Don't feel that I am progressing to get better.  Plateau?  Chronic pain affecting me; just need arm to stop hurting and work right.  Exhausted at days end.  December 7, 2007 Appointment with Dr. to go over blood panel results.  The blood work was excellent.  No issues.  Dr. ordered a CT scan.  Had CT scan that afternoon.  December 10, 2007 Called Dr. for CT results.  Scan showed swollen lymph glands left side of chest.  All else looked good.  Nothing on scan to point directly to shoulder pain.  Dr. scheduled appointment for December 13 at which time he went over the results in depth of CT scan and prescribed Vicodin for pain.  He referred me to Dr. (neurologist) and we scheduled an appointment for mid Jan. 2008.  December 14, 2007 Saw Reiki practitioner to work on my arm.  Results were minimal.  Slight improvement in ROM that day and next.  Pain did not improve.  Very discouraging.  December 18, 2007. Pain is persistent and not improved. Having trouble sleeping and performing job.  Simple movements like removing shirt, tucking in shirt and opening car door very painful.  Called Dr. to prescribe a pain med that wouldn't give me insomnia like the Vicodin on advice of pharmacist who said that it affects some people in that manner.  Dr. prescribed Percocet.  I am continuing to work the muscles in a light manner, with no weights, to keep the muscles from atrophy.  December 20, 2007 Saw massage therapist to work on arm.  This form of therapy seems to offer the most immediate relief and comfort, even though it is only temporary.  I'm going with it though...it's a few hours of relief and I'll take anything at this point.  Also, starting with head congestion today.  Feels like a cold coming on.  December 21, 2007 Full blown cold or virus happening.  Severe head congestion, fever, chills, body aches.  Feel awful...good thing I got the flu shot.  Ha ha ha.  December 24, 2007 All of the above symptoms with unproductive cough and weakness.  Ears hurt.  Appetite is not good...just want to sleep all the time.  Cancelled all appointments with clients for this week.  Just going to rest.  Arm still sore and painful when abducted away from body.  Not as painful during night though...not keeping me awake anymore.  Hard to be a personal trainer with an arm that doesn't work right.  December 25, 2007 Still feeling sick.  At the Christmas gathering, I was just sitting there and I started to have neck pain on right side.  I started rubbing it...became headache.  Told person I wanted to leave and asked someone for some ibuprofen.  She gave me a Tylenol/Percocet pain killer instead.  Did not touch it.  Had to stop at gas station where I downed 4 200 mg ibuprofen.  Felt nauseous and had to cradle my head in my hands.  Could not look at light.  Longest hour long drive ever to get home.  Just climbed into bed and headache slowly abated when lying down.  Had plenty of headaches throughout my life...this was different.  December 26 and 27, 2007 Still feeling sick and weak but slightly better.  Nose is congested and probably have sinus infection as discharge is greenish/yellow/slightly bloody.  Keep getting sharp pain in neck when I turn it sometimes.  Scary.  Did I pull something?  Stoke or aneurysm precursor?  December 31, 2007 Still feeling strange.  Nose congestion, short of breath, arm aches, and lack of energy.  Decided to walk about 4 miles round trip today to test my strength and cardio.  Had some trouble catching my breath but pushed on.  Tired when I got back to the house and felt chilled.  Tried to shovel some...very difficult.  Kept arm close to body and avoided abduction.  Very sore in deltoid, bicep region of left arm that night.  Needed ibuprofen.  So hard to do just the basic things like tucking shirt in, removing shirt over head, reaching for a glass.  Disheartening.  Went out for New Year's Eve.  Watching ice skating.  Felt uncomfortable in my stomach (like belt was too tight).  Went to dinner and started having stomach cramps.  Hardly ate any of my entree.  Went home, got into comfortable clothes, but didn't even feel like having champagne (very unusual).  2am woke up to use the bathroom...had diarrhea and felt weak.  Can't believe I'm coming down with something else.  Immune system must be shot.  January 1, 2008 Woke up feeling like I had been run over by a truck.  My whole body hurt; even my skin.  More diarrhea and nausea.  Felt chilled and weak.  By afternoon, felt I was dealing with flu bug or food poisoning.  Fever 100.5 lots of diarrhea, nausea (can hardly get water down), achy and body aches.  Went to bed.  I mustn't have any immune system left...I seem to be getting everything out there.  January 2, 2007 Nausea less intense today.  Don't feel like eating but will try some Jello and maybe soup tonight.  Stomach making lots of noise and some diarrhea still but less in quantity.  Nap in afternoon and soup stayed down at night.  Feel weak and still tired.  Weird chest discomfort when recumbent.  Woke up in middle of the night with it.  January 3, 2008 Feel better this morning.  Still weird in stomach and weak and dizzy.  Determined though to do some laundry, dishes, pay the bills, etc...small house chores.  Ok until I ate a can of chicken noodle soup.  Then stomach started with mild discomfort and churning.  Guess I'm not out of the woods yet.  I have to get better soon...I have to work next week.  Tomorrow I will go run some errands in town and see how that goes.  (Chest discomfort in morning before getting out of bed).  I think it's time to see Dr. to see what's holding me back from recovering from this.  January 4, 2008 Went to see Dr. about this bug that won't go away.  He's so good about getting you in the same day when needed.  We did chest xray to rule out pneumonia since I'm having that discomfort in my chest (left side, middle) and the xray was fine.  He put me on a z-pak of antibiotics.  Hopefully this will get the recovery process going.  I told him the arm was slowly improving and today I was able to tuck my shirt into my pants without too much pain.  That's a big improvement over a week ago...so maybe things are going to be ok.  January 10, 2008  Last dose of antibiotics was Tuesday and boy did that get me back on my feet quick.  I feel like I have a new lease on life.  Been working this week and did a fitness workout with the teachers.  I was very shaky and my left arm didn't want to work too good on some of the exercises but I persevered.  I need to get stronger.  I couldn't complete a tricep kickback with 3 pounds, so I reduced the weight to 1.5 pounds.  Much better but certainly pathetic considering what I usually do.  Still hard to open a car door and can't remove shirt over my head still.  Uncomfortable when in bed laying down on my back and abduct arm away from body (ie; reaching over to grab the blanket and pull over to me).  I hope I get everything back over time.  January 15, 2008  Discomfort in the arm is no different than a week ago...feels like a plateau.  My arm(s) shake a lot when I am doing workouts with my clients using light weights.  They have noticed I am still not well.  I still have pain when I go to move it during the night.  It's uncomfortable and not what it once was.  January 17, 2008 Went to see Dr. (neurologist).  He confirmed that he believes it is an allergic reaction to the flu vaccine I received and that there is inflammation in the area of the deltoid with radiating pain in left upper arm.  Numbness on back of shoulder present also.  He put me on DayPro for two weeks and hopes to ease the inflammation with this prescription.  He wants a follow-up call from me at the end of the prescription with results.  If no change he will do an EMG (NCV) test.  January 29, 2008 My arm started to become more sore today.  Night time was very uncomfortable again.  I can't think of anything different I've done over the last few days.  February 5, 2008 The arm has been pretty sore for the last five days.  Feels like a relapse heading back towards where I've just been with it.  I've also come down with a cough over the last few days.  Maybe I'm getting that cold that's been going around.  Just don't feel myself.  Called the neurologist on the 1st, and he scheduled an EMG for the end of February.  Hopefully, I won't need it because my arm will be better by then.  Wishful thinking?  February 6, 2008 Met with Dr. about some lumps on my right ear.  She thinks they are sebaceous cysts and has scheduled outpatient surgery for Friday the 15th.  Met with Dr. about rectal bleeding that I believe could be from hemorrhoids or anal fissure.  He did digital exam, didn't see anything serious but ordered up a rigid sigmoidoscopy for Feb 20th.  Not looking forward to that.  February 11, 2008 Over this weekend my cough was just terrible.  I felt down and super fatigued.  I had no energy all weekend.  Today, Monday, I'm feeling a little better.  I have modified my diet to a protein type diet and hope this helps in the healing process of all the things that are wrong with me.  I'm getting tired of being tired.  February 20, 2008 Last Friday had cysts removed from ear.  Stitches will come out in 10 days.  No complications.  Had sigmoidoscopy done today.  Not fun but doctor didn't see anything that needs further attention.  He noticed scarring where he thinks I had a small fissure which self healed over the last two weeks due to increased fiber intake (Metamucil) and relaxed diet.  The arm is still feeling different than the other one and I can not use the same weights that I do with the right arm during workouts.  EMG is scheduled for next week and I will keep the appointment.  I would like to know if there is damage to something which is keeping me plateaued at this level with it.  March 4, 2008 EMG results came back normal.  So that leaves me with assuming that my arm pain and myalgia will hopefully go away on its own someday.  I'm going to think positive thoughts and work it as hard as I can tolerate.  I hope someday it is normal like it use to be.  I know it was caused by a reaction to the flu shot I had so I will fill out an Adverse Reaction Form and send it in.  I'll never get another flu shot!  5/01/2008 MR received for OV 1/17/2008 with Dx: Myalgia injury site of Flu shot. Pt presented with 2 month hx of severe left deltoid pain which has been improving. Difficulty with activities such as removing shirt and physical work activities. Some numbness. PE (+) for point tenderness in the deltoid and limited abduction.  Tx with anti-inflammatory. 1/20/2010 Left arm is still sore. Nighttime is worse. Sometimes its very achy but less than 6 mos. ago, still trouble with abduction and strenght is less than it was.  Follow-up: I am the same as last reported. This adverse reaction (left arm pain and weakness) is problematic as I do personal training. It doesn't look good when the client can do more dips and pushups than the trainer can!