Age: 56.0
Sex: F
Vaccine: TDAP
Symptoms: Pain, Peripheral swelling, Pyrexia, Red blood cell sedimentation rate increased, Sleep disorder
Clinical narrative: On 8-4-2016, 2hrs after Tdap vaccine, I developed intense, burning pain in right shoulder, same side as injection but not at injection site.  Pain progressed rapidly to such severity that right arm was immobilized.  Pain rated at 10 out of 10 with active movement, 8 out of 10 without movement.  Treated with regular aspirin every 4-5 hours, which reduced pain from 8 to 7.  Pain continued unchanged from 8-4-2016 through 8-21-2016, when pain lessened slightly from 8/7 to 7/6. On 8-11-2016, nurse advised ibuprofen.  Took ibuprofen ~12:00pm, which actually increased the pain and caused the shoulder to feel more stiff.  This effect lasted for about 5 hours.  I did not take any more ibuprofen but resumed taking aspirin about every 4-5 hours.  On 8-16-2016, I was examined by Dr. at 10:00am.  Bloodwork showed that the inflammatory markers, C-reactive protein and SED rate were high, white blood count was high end of normal range.  In consultation with another doctor diagnosed an inflammatory reaction to the vaccine.  During the exam, both doctors noted that pain was not severe with passive movement.  Celebrex was prescribed.  I took one Celebrex at 1:30pm.  At 2:00pm, I began to feel feverish, body temp 100.7.  By 2:30pm, the shoulder pain had increased substantially and the shoulder was more stiff.  The sensation was the same as the effect of the ibuprofen except the pain and stiffness were more severe (9 on a 1-10 scale) and my right shoulder felt warm to the touch, and my right hand swelled noticeably.  There was no increased swelling in the shoulder or arm.  I contacted facility and a nurse said that Dr. strongly recommended that I go to the ER because Dr. was concerned about a possible infection in the shoulder joint.  But I went to the ER ~5:00pm due to the increased pain associated with the Celebrex.  X-rays were taken of my right shoulder and blood samples were drawn ~10:00pm.  At the time I was first examined by Dr. ~11:00p, about eight hours after taking the Celebrex, the swelling in the right hand had abated and the shoulder pain had returned to the 7/8 level.  As before, bloodwork showed inflammatory markers high.  In the examination, Dr. also noted the difference in pain between active and passive movement, and he reasoned that the greater pain during active movement logically suggests that the source more likely involves the tendons in the shoulder rather than the shoulder joint.  Dr. concluded that sepsis in the joint was unlikely, but he was unable to identify the cause of the inflammation and unable to rule out a serious problem.  Dr. was aware of the CDC information on vaccine side effects that describe this problem as a known, but rare side-effect of vaccines, so he referred me to Orthopedic clinic for further examination.  Dr. also prescribed Tramadol for the pain, but it had no effect.  I resumed taking aspirin every 4-5 hours.  On 8-19-2016; Went to Orthopedic clinic, brought x-rays, was examined by PA.  Upon examination, PA was confident there was no joint sepsis and believed the inflammatory reaction would resolve on its own.  I was still unable to sleep for more than brief periods each night due to the pain.  PA recommended melatonin for sleep and ibuprofen for pain.  I did not take ibuprofen due to the adverse reaction experienced previously and did not attempt sleep aids because it is the pain that interferes with sleep. Also on this date, I began to develop symptoms of a viral infection, typical of the common cold, including sneezing, head congestion, sore throat, mild headache, body aches and weakness.   Symptoms continued through 8-27-2016 and remained moderate with a maximum body temperature of 101.2 degrees. 8-21-2016; Cold symptoms continued but shoulder pain noticeably lessened from an 8/7 to a 7/6, that is, 7 without aspirin and 6 with aspirin.  This slight reduction in pain was sufficient to permit sleep, but the pain has remained at this level through 8-27-016 with no trend of improvement.  8-27-2016; As of today, the shoulder pain remains unchanged from 8-21-2016 and little changed from 8-4-2016.  Although the cold symptoms are abating and sleep is improved, I continue to experience generalized weakness and fatigue.  Problem has not resolved and it is unknown whether disability will be permanent. Additionally, simultaneous observation of both the left and right shoulders during passive movement shows distinct differences in the shape of the shoulder muscles.  When I place both of my hands side-by-side on a mirror in front of me at chest-height, then lower my body to flex my arms upward, I can see a normal crease in the left shoulder as it bends, but there is no crease in the right shoulder and the pain limits the full upward range of motion even under passive movement.