Age: 45.0
Sex: M
Vaccine: FLU4
Symptoms: Injection site pain, Joint range of motion decreased, Product administered at inappropriate site, Shoulder injury related to vaccine administration
Clinical narrative: 9/27/2018 I received a flu shot this day around 2PM, on the campus. At the time, I noticed that the injection seemed to be too high up my left arm, going in just below the shoulder joint. It hurt more than the flu shots did as I remembered them. I also felt an unusual painful pressure as the vaccine was injected. Normally I feel the needle stick but don't notice the vaccine going in, but this time I definitely noticed it. As I walked back to my office, my arm didn't particularly hurt, and I had a regular range of motion. By that night, my arm was hurting a lot. I had to take an Advil just to sleep, and I don't ever remember having to do that despite getting flu shots annually for the last 15 years or so. I didn't need an ADVIL the next night. 10/4/2018 - Over the next 7 days, the pain gradually lessened but didn't go away completely. By around Thursday Oct. 4, I had a relatively normal range of motion, although it still hurt, and the pain was noticeable. 10/7/2018 - I noticed that the pain had been getting worse the previous day and today. By Sunday evening, I had to take an ADVIL again before bed at 11pm. This was the first time since the night of the flu shot. I felt a dull ache with my arm just hanging at my side. Lifting my arm at the shoulder joint was prohibitively painful, although I could lift my left arm using my right arm, and that wasn't nearly so painful, so it seems that using the muscle is what hurt. By probing around my shoulder joint, I noticed some tenderness around the upper deltoid muscle, and the outer bursa seemed painful with anything more than the lightest touch. It has now been 10 days since the flu shot. I should note that my right shoulder had no pain at all nor any movement limitations during this entire time. I have not had any pain in either of my shoulders prior to this for as far back as I can remember, which is many years, except for mild muscle pain lasting about 3 days after each immunization in my left shoulder. I've never had anything like this before. 10/8/2018 Went to walk in clinic. The nurse practitioner confirmed the shot was given too high, as she saw the injection mark. She noted suspected SIRVA. I was prescribed 400 mg ibuprofen 4-6x daily for 3-4 days to break the inflammation. If that works, fine. If not, oral steroids. 10/11/2018 took 400 mg ibuprofen about 5x/day for last 3 days. Stopped taking due to swelling in legs after 72 hours. Pain was much improved and range of motion improved, but not perfect, while I was on ADVIL. 10/13/2018 pain returned last night, woke up at 3:45am and couldn't sleep. Took 400 mg ADVIL. Shoulder still hurt most of the morning even at rest, but felt better in the afternoon even as ADVIL wore off. Can't lift left arm too painful, even with ADVIL. 10/15/2018 Was able to sleep last night without ADVIL, but arm still hurt. Yesterday and today the pain is a constant dull ache that becomes a very sharp pain if I try to lift my arm. I am changing my daily routine now to avoid wearing sweaters and pullover shirts as much as possible, because it hurts too much to lift my arm to take off a shirt. At the moment I can just barely lift my arm despite the pain. Any more pain, and I would be unable to lift it. This morning I made an appointment to see a sports medicine doctor Oct. 23.  I'm concerned to get physical therapy to maintain strength and range of movement and to avoid adhesions from the injury. 12/5/2018 spoke w/ Nurse of student health.  Vaccine is FLUARIX QUADRIVALENT vaccine. Made by Glaxo Smith Kline. 12/5/2018 Continuing with physical therapy. I still cannot apply force to move my arm outward without prohibitive levels of pain. I have difficulty taking my pullover shirt off. I have some improvement but still limited movement and pain.