Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Imaging procedure, Pain assessment, Physical examination, Shoulder injury related to vaccine administration
Clinical narrative: Alleviation of shoulder injury related to vaccine administration (SIRVA) pain and disability; Alleviation of shoulder injury related to vaccine administration (SIRVA) pain and disability; This is a literature report.  A 54-year-old male patient received BNT162b2 (BNT162B2 NOS), as dose number unknown, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION (medically significant), ARTHRALGIA (medically significant), outcome "recovered" and all described as "Alleviation of shoulder injury related to vaccine administration (SIRVA) pain and disability". The patient underwent the following laboratory tests and procedures: Physical examination: The pain intensity was rated as an 8-9/10. There was also a mild-to-severe pain in the neck described as an 'odd pain' that throbbed, where the patient scored a 70% on the neck pain disability questionnaire. Cervical range of motion (ROM) showed a severe loss of extension mobility, a significant limitation in bilateral side bending as well as a moderate restriction in bilateral rotation. Any pressure on the head in any position exacerbated the shoulder pain particularly backwards motions. There was severe restriction on left shoulder motion above the horizontal not due to restriction but due to severe pains, there was no restriction to right shoulder motion. Imaging Examination: Radiographic assessment was performed and analyzed using the PostureRay EMR. The radiographs showed a very hunched neutral standing alignment. In the cervical region, the patient had a 65.7 mm forward head posture, (vs. normal <15 mm)), a flexed atlas plane line (APL: +2.6 degree vs. -24-29 degree)) and reduced cervical lordosis (-14.2 degree vs. -31-42 degree normal)). The patient also had a T2-T11 thoracic hyperkyphosis (56.0 degree vs. 42 degree normal)) and a forward lean (horizontal distance between T1 and T12) of 62.1 mm (vs. 0 mm ideal)). On the lumbar view the patient demonstrated a 71.3 mm posterior thoracic translation (vs. 0 mm normal)), a loss of lumbar lordosis (-17.2 degree vs. -40 degree normal)) and a reduced sacral base angle (SBA: 31.9 degree vs. 40 degree normal)). Treatment: Chiropractic BioPhysics (the primary purpose being to reduce the FHP and forward postural lean and thoracic hyperkyphosis). The patient progressed to performing 50 repetitions daily. Spinal manipulative therapy (SMT) was performed on the cervical, thoracic and lumbar spine bilaterally. Outcome: The patient experienced rapid pain relief with treatment, and it is noted that after 1-month of treatments (13 sessions) the patient reported 'feeling great.' The shoulder pain was rated a 0/10 after 33 treatments.; Sender's Comments: As there is limited information in the case provided, the causal association between the events shoulder injury related to vaccine administration, arthralgia and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available. 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.