Age: 49.0
Sex: M
Vaccine: HEPA, IPV, TYP, YF
Symptoms: Asthenia, Musculoskeletal stiffness, Pain, Paraesthesia
Clinical narrative: On December 30, 2004, the patient was scheduled to received the second Hepatitis A vaccination, six months after the first vaccination.  The RN asked how the patients trip had gone.  The patient replied "great except the yellow fever shot reaction was the most pain I had ever been in".  The lead to a discussion with the RN.  The RN asked the patient to write down what had happened so the information could be forwarded to the CDC.  The receipt of the second Hepatitis A shot has been delayed. 06/28/2004 - The patient received Hepatitis A, Polio IPV, Typhoid oral capsules (4) and TB skin test. 07/01/2004 - The patient received the yellow fever shot. 07/06/2004 - The patient went to bed the previous evening feeling fine.  When the patient woke up in the morning the patient had stiffness in the upper back around and to the left of the spine.  The patient kept trying to stretch it out but with no improvement.  It was unlike anything else the patient felt before.  It was still and uncomfortable, but not extremely painful.  The patient had trouble sleeping, doing a lot of tossing and turning and only finding a position or two that the patient could catch some sleep. The patient lifts medium amounts of weights, using machines twice a week for fitness purposes.  The patient had not experienced any previous problems associated with weight lifting.  Now, the patient had lost a majority of strength in the left arm.  The patient quit lifting weights until about 10/01/2004.  Since then, the patient has rehabbed and gained approximately 90% of strength back.  Six weeks after the initial pain, the patient was still unable to do 1 push-up.  The left arm would not support the patient's weight.  On 09/20/2004, with great difficulty the patient could do 10.  Today the patient can do 20 with relative ease. 07/08/2004 - The patient called the RN and complained of stiffness in the upper back that was thought to be related to the yellow fever shot.  The RN told the patient to see their personal physician.  The patient saw their personal physician and briefed him on the shots received.  The physician performed a number of tests (pulling, pushing, and pressing) and stated that things were fine.  The patient had no fever etc.  The physician prescribed a 5 day supply of muscle relaxant and stated that the problem will probably go away before the 5 days are over. The prescription provided no relief; it was like the patient had not taken anything. 07/10/2004 - The patient's pectoral (chest) muscle on the left side over the heart started to twitch from time to time.  When it first happened, the patient briefly considered going to the ER, thinking it may be the heart.  This lasted intermittently for a week or so. 07/14/2004 - Since the patient felt no better, he saw his physician a second time to make sure he had not serious health problem since he was going out of the country in 3 days.  The Dr. stated everything was fine and the pain was probably from the shots.  The Dr. stated in due time things would return to normal and to take Motrin.  The patient took Motrin intermittingly for 7 weeks. 08/07/2004 - The patient was introduced socially to a physician who practiced out of the country.  The patient told this physician about the symptoms and how he believed it was from the yellow fever shot.  The physician responded that he was aware of these symptoms and that the patient would be OK. 09/01/2001 - Around this time the patient stated feeling a new sensation.  Several times (3-7) per day would get a tingling sensation that started from the middle of the left shoulder blade, running down the arm to the tips of the 2 fingers next to the thumb.  This lasted until mid-October.  At times the patient could still feel where one of the vaccinations was given in the left arm muscle. Additional Information:  In 1960 when the patient was 5-6 years old.  The patient received childhood vaccinations in the right arm.  The arm became extremely sore and had an indentation in the muscle from where the shot was given that remains today.  The patient was told that it was due to a dirty needle.  The patient mother told him that it was the Diphtheria, Whooping Cough and Tetanus Shot vaccinations.  The patient has documentation tat he received these and the 4th polio shot in January 1960.