Age: 43.0
Sex: F
Vaccine: VARCEL
Symptoms: Injection site pain, Injection site warmth, Joint range of motion decreased, Muscle atrophy, Pain
Clinical narrative: Information has been received from a 43 year old female consumer/health care provider with a history of seizure, cervical cancer and allergies to pcn, iodine and Tegretol who on 06/28/2001 was vaccinated with one dose of varicella vaccine in the right arm. Concomitant therapy included Dilantin, vitamins and Estrace. The reporter was concerned that the vaccinee was administered incorrectly. "The nurse injected the vaccine way back in the fatty tissue of my right arm." Since then, the pt reported that she developed a hematoma of the right arm, larger than half-dollar in size, fatigue and weakness. Follow-up received from a nurse in the physician's office indicated that she was seen on 07/03/2001 with complaints of pain in her right upper extremity, sever, since vaccination. She also stated that it felt hot and reported some itching sensation. On 07/01/2001, the right arm was reportedly swollen and by 07/03/2001, at the time of exam, the swelling had "gone down." The physician noted "well-developed in no acute distress" and "some swelling at the posterior aspect of her humorous, tender to touch, and not warm." In addition, her right shoulder was noted to be tender, ROM was noted as "flexion 90 degrees, abduction 90 degrees." It was documented as "early restriction of range of motion." The hematoma was noted on her right upper extremity. She denied numbness, nausea, and vomiting. The pt also stated that she had a temp of 101 deg. F on 06/30/2001, that lasted one day. It was reported that she has been afebrile since. The pt was treated with moist heat to the affected areas, Benadryl and Darvocet N-100 for pain control and was instructed to "use her arm as much as possible so that it will not get stiff." On 07/09/2001, she was reevaluated by the physician. That same day, it was reported that the hematoma on her arm was "better" and "essentially resolved/resolving." At that time, she denied erythema, but reported feeling fatigued since vaccination. It was reported, on 07/09/2001 that she "now" complains of pain in the right shoulder, extending down to her right scapular area and  pain and discomfort with range or motion. It was also reported that she had no numbness in her arms and denied any trauma. Physiican exam findings at that time revealed the pt to be "in no acute distress." It was reported that her right arm showed evidence of tenderness to palpation along the supraspinatus and infraspinatus muscles. There was also tenderness noted at the levator scapular muscles and subacromial joint space. There was "no evidence of erythema, no color." She was reported to have had a positive Neer's sign. It was noted that "range of motion was shorter flexion 35-40 degrees, abduction 135-140 degrees." She also had mild decrease in external rotation range. Motor exam of the upper extremities was 5/3 and sensory exam was reported to be intact. She was diagnosed with myofascial pain and right shoulder tendonitis. It was noted that the tendonitis was "most likely due to the fact that she has been doing a lot of overhead activities at work, reaching and starting IV lines." She was placed on Ibuprofen and Darvocet N-100 prn. She was instructed to avoid repetitive overhead activities and to begin a course of physical therapy "to work on range of motion modality with cryotherapy and ultrasound, then progress to strengthening exercises." She was to return to the clinic for re-evaluation, in two weeks. It was reported that on 07/09/2001, pain, redness and itching of the right upper extremity resolved. That same day, on 07/09/2001, the "hot" sensation of the right upper extremity resolved. The swelling ended within 2-3 days. The physician also reported that the fatigue resolved within 11 days, on approximately 07/09/2001. Howver, the pt reorted that the night prior to her call on 07/10/2001, she slept 16 hrs straight. On 07/19/2001, it was reported that the right shoulder tendonitis and myofascial pain resolved and she was permitted to return to work without restrictions. It was also reported that no further medical treatment would be required. No further info is available.