Age: 81.0
Sex: M
Vaccine: RSV
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Laboratory test
Clinical narrative: "We again discussed patient's presentation. He described that his symptoms initially began in June. He says that he was mowing his lawn when his lawn mower got stuck on the side of a small hill. He needed to move it to flat land to restart it. He says he was pulling on a lever with his left hand. Approximately a week after that he developed pain in his left shoulder and arm. This slowly progressed to left arm weakness in addition to left arm pain. He stated that he later also developed tingling pain in his fingers on the left. He states he went to his doctor for left arm pain and weakness where they prescribed him pain medications. Per chart review, he went to Medical Center on 7/2/2024 for left arm pain. Per note, "Patient is here due to continued reaction to injections he got 5/16 in his left upper arm: tetanus and RSV. the area is warm, swollen, red and tender to the touch extending fromjust above the elboe up to the shoulder. Assessment/Plan: He recieved tetanus and RSV in left arm 5/16/2024 and has has redness swelling warmth and tenderness in upper left arm since  adviced to start Tylenol ES 650mg and Ibuprofen 200mg one each up to 4 x a day with food and start OTC Bemadryl at bedtime for a few days as needed."    He was also seen in the ED at Hospital on 7/10/2024 for left arm swelling. Per ED provider note, "Patient is a 81-year-old male who had a RSV and tetanus vaccine in his left bicep on 5/16/2024 and states that following the tetanus he was feeling a little bit sore.  Patient reports that he then had improvement of this pain.  Approximately 3 weeks ago patient began to develop some pain in his left upper arm and over the past couple of days he has lost the ability to flex his left elbow.  He is able to extend his elbow.  He has some redness to his left upper arm.  No fever or chills.  He denies any chest pain or shortness of breath." His exam at that time per note, "Unable to flex elbow beyond 90 degrees.  4/5 strength of left elbow extension.  2+ left radial pulse.  Left upper arm with mild erythema.  Area of bruising to left medial distal bicep."  He was recommended for outpatient follow up with orthopedics.   He states that afterwards, he was lifting an air conditioner in his house and felt as though he hurt his right arm. He says approximately a week afterwards he developed pain and then weakness in his right shoulder as well as arm. Per chart review this occurred on or around 7/11/2024. He had MRI of his c spine completed on 7/24. He was seen by Neurosurgery outpatient at Hospital on 8/7. Given degree of weakness, recommended repeat MRI, urgent/emergent Neurology consultation, and possibly urgent/emergent surgery. He was seen by Dr. on 8/9 who recommended he go to the ER for expedited workup of other potential causes. He was originally scheduled for the OR on 8/12 but this was deferred.   Interval Events: -EMG/NCS completed by Dr. on 8/13, findings not consistent with polyradiculopathy, concern for Parsonage Turner syndrome/brachial plexitis -MRI c spine reviewed with Neuroradiology, concern for possible chronic septic facet joint, again confirmed neural foraminal stenosis, no critical spinal canal stenosis -Patient reports no improvement/slight worsening in weakness"