Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Pain in extremity, Paraesthesia, Parosmia, Taste disorder, Tremor
Clinical narrative: Development of new onset neuropathy symptoms after moderna covid vaccination.  Patient age 61 with trigeminal neuralgia, migraine headaches, and history of rheumatoid arthritis. Received Moderna vaccine doses on mar 2 and mar 30, 2021. Had reactions to both shots, detailed in V Safe (including, increased migraines, chills, fatigue, nausea, mouth sores). May 25th, after dose #2, developed new onset hyperesthesia in dermatome distribution (horizontal band from R lower back and extending around to front, for about 5 days), and then 2-3 days later developed another band about june 1 over R trapezius around to R upper chest) and was seen in Neurology headache clinic on 6/7/21 at which time it was fading.  She never had paresthesias before this time.  Discussion by clinician at that time was of zoster without rash.  Of note, Pt's sister also developed shingles within 8 weeks after her second covid shot.   She has subsequently developed paresthesias, neuropathy and other symptoms (abstracted from chart and notes):  6/28 Another area of hyperesthesia(describe location), mouth sores for several weeks, some nausea and sleeping problems. 7/23 nerve pain comes back, nausea chills fatigue and headache 7/29-30 nerve pain comes and goes, sense of taste and smell altered, hair loss 8/11 increased symptoms, constant tingling/burning and pins and needles, legs feet and arms and some on lower part of face and back, nausea, fatigue cold sores and sores on tongue 8/13 increased symptoms, bad headaches and completely lost appetite for several days, along with loss of smell and taste.  8/16 still constant tingling lower legs and feet, as well as legs back of pelvis arms and tingling in hands which was new. Sense of taste and smell still altered and affecting appetite. Episode of shaking yesterday, not due to nervousness.  8/18 Woke shaking again last night.  8/20 Seen at urgent care 8/23 Increased symptoms. Woke yesterday with new cold sore, and had a bad night, shaking, and nerve tingling on arms legs left side of back and moving through spine in sections, and back of head with nausea and headache.  8/24 MRI of brain performed, (Note: order incorrectly stated history of demyelinating disease, ordering clinician confirmed this was never diagnosed or discussed. ) 8/25 Increased symptoms, another bad night, woke at 230am with quivering on lips and face, and eventually entire body. Sensations on base of skull and neck which turned into shaking arms/legs with tingling especially on left side and left leg became painful for a while, with light headache and nausea 8/26 MRI brain without infusion, (note: history of demyelinating disease is incorrect-ordering clinician confirms this was not diagnosed or discussed) Seen at urgent care 8/28-29 Seen at emergency room, sent by neurologist and nurses for evaluation of increasing symptoms, not for anxiety. Neurology consult by Dr overnight EEG and MRI of C Spine performed 8/30 woke up shaky tremors, tremors in voice and head shaking, can?t smell taste or eat for 4 days 8/31 bad night, still shaking, appetite totally gone, lost weight 9/1 woke up super shaky arms hands neck head, very shaky inside and nerve sensation back of legs and bottom of feet, hands trembling with pins and needles, tremor in voice, sense of smell partially returned 9/2-9/3 quiet somewhat better 9/4 woke at midnight till 4, new tongue sores, L side this time, last time R side; woke with  nerve sensations back of arms and legs, wobbly legs impair walking, increased symptoms with day tremors, in afternoon all out tremors and shaking, headache and sensations back of head. 9/7 in addition, severe L sided headache and resulting in numbness of L side of face, and burning and tingling on entire L arm and burning and tingling on L leg. 9/8 seen at emergency room, CT scan of brain performed  Symptoms are worsening and nights are horrible, including increasing tremors at night and now more even during the day. Pt is mostly lying down during the day, and has diminished ability to perform many activities of daily life.