Sex: M
Vaccine: COVID19
Symptoms: Electromyogram, Magnetic resonance imaging, Nerve conduction studies, Neuralgic amyotrophy, Orthopaedic examination
Clinical narrative: Parsonage-Turner Syndrome; This is a literature report.  A 34-year-old male patient received bnt162b2 (BNT162B2), in Jan2021 as dose 2, single (Batch/Lot number: unknown), in left deltoid for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (DOSE 1; MANUFACTURER UNKNOWN), for covid-19 immunisation. The following information was reported: NEURALGIC AMYOTROPHY (medically significant), 6 weeks after the suspect product(s) administration, outcome "recovered", described as "Parsonage-Turner Syndrome". The event "parsonage-turner syndrome" required physician office visit. The patient underwent the following laboratory tests and procedures: Electromyogram: studies were planned if, notes: symptoms had continued to progress, but because presentation and clinical examination were diagnostic and symptoms self-resolved, these studies were deferred; Magnetic resonance imaging: was negative for intramuscular, notes: or other soft tissue abnormalities; Nerve conduction studies: showed 4 of 5 strength of the, notes: right deltoid, latissimus dorsi, subscapularis, supraspinatus, infraspinatus, and biceps with 5 of 5 strength in elbow extension, wrist flexion and extension, and hand intrinsic function; symmetric and intact, notes: to light touch and pain; Orthopaedic examination: negative, and there was no instability of the, notes: shoulder; physical examination: had atrophy of the right shoulder, notes: girdle, including the deltoid, latissimus dorsi supraspinatus, infraspinatus, and biceps. Therapeutic measures were taken as a result of neuralgic amyotrophy.  Clinical Course: Parsonage-Turner syndrome (PTS), or neuralgic amyotrophy, is a rare brachial plexopathy of idiopathic etiology that is typically characterized by the abrupt onset of shoulder pain lasting for days to weeks. It is unresponsive to analgesics, followed by paresis of the upper extremity musculature and in some cases even sensory paresthesias. This uncommon syndrome, which has an estimated incidence of 1 per 1,000 people, was first observed in the late 1800s. Since then, further studies have failed to uncover a precise etiology for the condition but have found associations between PTS and many clinical scenarios, including but not limited to postoperatively, postinfectiously, or even postvaccination. After the emergency authorization of the first COVID-19 vaccination on December 11, 2020, there has been considerably increased interest in identifying potential side effects of the vaccines. As global COVID-19 vaccination efforts have become more pronounced and a greater percentage of the world population is becoming vaccinated, there have been scattered reports of patients presenting with neurological complications after vaccination. We present the case of a healthy 34-year-old man who developed PTS after COVID-19 vaccination. A 34-year-old right hand dominant healthy man received the second dose of the Pfizer COVID-19 vaccination to the left deltoid in January 2021. One week after this event, he experienced severe pain in his neck, right shoulder, and periscapular region that awoke him from sleep. For the next 2 weeks, he continued to experience pain that worsened at night, improved throughout the day, and did not respond to nonsteroidal anti-inflammatory drug administration. Throughout this period of pain, he denied any weakness and reported that his performance with regular resistance training was unchanged. He denied any recent respiratory illness or surgery. Two weeks after the onset of symptoms, he reported that his pain diminished and was replaced by a deep dull pain along the posterior shoulder. In addition, he began to experience new-onset weakness in his right shoulder and arm that he noticed because he experienced a greater than 50% decrease in the amount of weight he could lift while resistance training. Symptoms were isolated to the right arm, and he denied any sensory symptoms, such as numbness or dysesthesias. He also noted that his shirts began to fit more loosely around his right arm and shoulder, which prompted him to seek medical care. At 5 weeks from initial pain onset and 3 weeks from onset of weakness, the patient was evaluated by an orthopaedic surgeon. On physical examination, he had atrophy of the right shoulder girdle, including the deltoid, latissimus dorsi, supraspinatus, infraspinatus, and biceps. Muscle bulk of the hand, forearm, and triceps was symmetric. Sensory examination was symmetric and intact to light touch and pain. Motor examination showed 4 of 5 strength of the right deltoid, latissimus dorsi, subscapularis, supraspinatus, infraspinatus, and biceps with 5 of 5 strength in elbow extension, wrist flexion and extension, and hand intrinsic function. The Spurling test was noted to be negative, and there was no instability of the shoulder. Muscle bulk of the hand, forearm, and triceps was symmetric. Sensory examination was symmetric and intact to light touch and pain. Motor examination showed 4 of 5 strength of the right deltoid, latissimus dorsi, subscapularis, supraspinatus, infraspinatus, and biceps with 5 of 5 strength in elbow extension, wrist flexion and extension, and hand intrinsic function. The Spurling test was noted to be negative, and there was no instability of the shoulder. Patient presented with a classic case of PTS, experiencing sharp and acute onset shoulder pain in the setting of an identified trigger (COVID-19 vaccine) that slowly receded and was replaced by weakness of his right shoulder girdle that self-resolved over the course of months.  patient presented with a classic case of PTS, experiencing sharp and acute onset shoulder pain in the setting of an identified trigger (COVID-19 vaccine) that slowly receded and was replaced by weakness of his right shoulder girdle that self-resolved over the course of months. Although clinical history and physical examination can sufficiently diagnose PTS, other diagnostic modalities, such as EMG and MRI, can be pursued to both identify characteristic findings of PTS and exclude other diagnoses. The patient, who was a healthy young man engaging in resistance training, a musculoskeletal pathology such as labral tear or peripheral nerve compression was originally suspected. However, the presence of significant muscle wasting nonspecific to a nerve root or peripheral nerve, no shoulder instability on clinical examination, and a normal shoulder MRI suggested a more systemic condition. As the rates of both COVID-19 infections and vaccinations have steeply increased over the past year, it is increasingly important that complications of both are identified and characterized. There have already been multiple reports of patients developing PTS after COVID-19 infection. As the rates of both COVID-19 infections and vaccinations have steeply increased over the past year, it is increasingly important that complications of both are identified and characterized. There have already been multiple reports of patients developing PTS after COVID-19 infection.; Sender's Comments: Based on the temporal association, there is a reasonable possibility of a causal association between the event neuralgic amyotrophy and the suspect drug BNT162B2.  The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.