Age: 48.0
Sex: F
Vaccine: TD
Symptoms: Electrocardiogram normal, Erythema, Fatigue, Headache, Hypersomnia
Clinical narrative: Patient explained that she received a TD injection on Friday, Sept 23rd, 2005. Next day, on Saturday, patients arm was very sore and it swelled up, about 2 inches high, the size of the tangerine. Subsequently, the pain moved from the arm to her neck, then to her head, then to another arm, soon all of her muscles were in pain and she experienced muscle spasms. Patient had a high fever and could not move because of pain. Patient said that she saw her doctor on Monday and the doctor told her that she is probably having an extreme allergic reaction to TD. Patient saw additional doctors who agree that she had a severe reaction to TD, her eye doctor said that her eye twitching was also due to adverse reaction and it will go away in about a month, and it did. Patient went for a physical therapy, where she was told to stop her cardiac workout, just in case. Patient was experiencing minor difficulties breathing, which she associated at that point with discontinuing the cardiac workout. Patients symptoms were becoming milder until Christmas time, when her symptoms flared up. Patient said that slight shortness of breath she was experiencing before, while doing activities, such as walking up the stairs, got worse. At one point patient experienced tightness in her chest and the symptoms of the heart attack. Patient ended up in the hospital where her nuclear stress test EKGs were abnormal. However, doctors could not find any blockages and were confused. Follow up received on 2/14/06, Lot number of the TD vaccine that the patient received is TD 143. Patient said that she still has muscle spasms. Patient continued to say that she has seen now many specialist immunologist, endocrinologist (who is also her primary health care provider) and recently she saw a cardiologist. Patient said that the difficulty breathing is due to the muscle spasms of the lungs. Cardiologist conducted a breathing test and said that she has a non inflammatory asthma, and that her that difficulty breathing has nothing to do with cardiac complications. Doctor said that the possibility of muscle spasms being due to TD injection can not be ruled out. Patient said that, as doctor recommended, she is not working for another week and after that she is going to work part time. Follow up received on 2/17/2006, Patient reported that she received TD as a routine booster, no other vaccines were administered at that visit, her last TD was at least 10 years ago. She said that approximately 6 hours after the injection her arm was red and felt sore. By the next evening, her right shoulder was in pain and then the pain moved from her arm to her neck, head to all muscles. She felt chilled and had a temperature between 100-101F. AT 48 hours after the injection it hurt to walk and she experienced muscle spasm as the myofascia being inflamed. She took ibuprofen but it did not really help. On Monday (72 hours post injection) she saw her primary doctor, who told her that she had a severe adverse reaction to TD, but would do some blood work to rule out other causes. Patient said that at this time her arm was still swollen and she had a slight fever. She recalls no rash nor other skin lesions. At 7 days after the injection, patient said that her arm was better but she was still having muscle spasms in general, including her eye. She saw an ophthalmologist who said that this is from a reaction to TD, but would go away over 3-4 months. Patient said that the muscle spasm with her eyes have gone away, although her eyeglass prescription might need to be changed as she believes she does not see as well. Patient was feeling better until around Christmas time when she started to feel short of breath and get tightness in her chest. Patient mentioned that she has a history of spinomylagia and has a history of C5, C6 fusion, but later said that she has a history of fibromyalgia. Patient then described that since this January, she has experienced chills and low grade fever for 5 days and intense soreness all over her body. She experiences tightness in her chest with difficulty breathing, especially when trying to exercise. She uses her Nordic track less due to pain in her right arm. Patient said that on a recent Saturday night, she felt nauseated and vomited a little. She was brought home and experienced extreme pain in her chest that radiated to her arm and neck. She called 911 and was brought to the hospital where she stayed for 2 days. She reports her diagnosis from that admission as not a heart attack, her stress test was normal (no blockage) and she was told her ECG was a normal variant for her age. Patient said that she has seen specialist for these symptoms. Her primary doctor is having her chest tightness symptoms evaluated further. Patient said she has been told she has a non inflammatory asthma as she gets a cough with chest tightness, but has no wheezing on exam. She has seen an endocrinology/immunology specialist who has told her that her reaction is from her immune reaction to TD. She understands that she is having muscle spasms in her chest and lungs that are causing these symptoms. The specialist has told her that it will take 6-8 months to fell better. Currently, she is doing pool therapy to help with the muscle spasms and says she feels her lower extremities are improving, but still can't do a lot with upper extremities. She tried taking a stronger anti inflammatory, but it made her feel bad so she stopped. The specialist may start giving her injections to help with muscle spasms. Patient said that overall, she feels that she is a little better. She does remain quite fatigued, needing 9-10 hours of sleep a night instead of her usual 6-7 hours. She has been off work the past 2 weeks, plans to start working part time next week. Patient says that she will be continued to see specialists and has a breathing test scheduled within next couple of weeks. 60 day Follow-up Information 18-JUL-2006: Attempts to obtain the follow up information were unsuccessful.