Age: 38.0
Sex: F
Vaccine: FLU3, TDAP
Symptoms: Bone marrow oedema, Drug administered at inappropriate site, Erythema, Injection site pain, Joint range of motion decreased
Clinical narrative: Two vaccines given high on left arm near top of shoulder. Injections were incredibly painful and the vaccines burned. Left arm was very sore that evening, and the pain progressively worsened. Within the next couple of days the pain was so intense I could not sleep at night and took TYLENOL and ADVIL all day to dull the pain just enough to be able to function. Pain radiated from below the injection sites up to my neck. There was a constant throbbing, burning pain and my arm was swollen, red, and warm to the touch. My range of motion was limited and moving my arm produced sharp, intense pain. On 2/16/2016 I had a medical visit with another doctor in the clinic for the pain. The doctor examined me and questioned why both injections were in the same arm. He stated that usually they are given in different arms in case of a reaction. He and his nurse agreed that the injections were too high on my arm. The doctor noted that my arm was red, swollen and warm to the touch. He stated that he would recommend a shot of steroids, but understood that I would probably not want a shot so he prescribed oral steroids. He suggested antibiotics, but I was already taking BACTRIM which is what he would prescribe so he advised me to finish taking them.  X-rays taken at this visit were unremarkable. The steroids helped ease some of the pain temporarily, but the pain gradually increased again. Almost two weeks after stopping the steroids it was still very painful to move my arm, especially to get dressed or when turning the steering wheel in my car. I made an appointment with an orthopedic specialist on 3/15/2016. The doctor ordered X-rays and examined my left shoulder observing  limited movement. He prescribed Tramadol for the pain and he ordered an MRI. I had an MRI on 3/21/2016 and received results on 3/24/2016. The doctor stated that the muscle was irritated and there was swelling and inflammation. He stated that there was edema in the bone and asked me if I recalled feeling the needle hit the bone. I told him that I don't know for sure if it hit the bone, I just know it was incredibly painful.  He stated that the edema could indicate infection in the bone or it could be because the bone and rotator cuff are bruised. He ordered blood tests to check for infection. I have been on antibiotics twice since this happened; once for the swelling in my fingertips and then again recently for strep throat. I can't imagine how I would still have any infection after that. Lab results were received on 3/28/2016. My platelets were slightly over the high mark, but not high enough to indicate infection. The doctor prescribed another round of oral steroids along with an anti-inflammatory to take after I finish the steroids. On 4/18/2016 I saw the orthopedic doctor for a follow up.  He checked my range of motion and we discussed my pain. My range of motion is still limited and I have pain in my arm from just above my elbow all the way up to my neck. The pain is a constant ache with very sharp pain when I move a number of different ways. The pain increases throughout the day and by the end of the day it has gone from a dull ache to a burning, throbbing pain. My upper arm becomes red, warm, and tender to the touch. The doctor suggested continuing the anti-inflammatory and the pain medication. We discussed a steroid shot and physical therapy. I am terrified of having a shot in the same area so we discussed another round of oral steroids instead. After going over side effects of taking three rounds of oral steroids so close together and deciding against it, we decided that I would try physical therapy. If I am still in pain after the physical therapy, I will take the steroid injection. I am waiting for approval from my insurance company to start the physical therapy.