Age: 51.0
Sex: M
Vaccine: FLU4
Symptoms: Arthralgia, Chills, Feeling abnormal, Feeling hot, Impaired work ability
Clinical narrative: 09/24/18: 08:30 Flu Shot taken. 09/25/18: Achy with 5 PM fever/chills and more chills while sleeping. 09/26/18: Patient went to work, woke up fine with some aches no fever. 3 PM: Felt warm in arms/hands felt achy felt different at 3 PM, arms and hands have full function. 7:30 PM: Called his boss, was taken to emergency room and felt likes something was wrong. Treated at Medical Center. Patient was seen by doctor but not treated with anything. Dr. diagnosed as bad reaction to flu shot and advised to take off next shift and to take ibuprofen. He then was discharged and sent home. Later that day severe pain in left hand with less than 10% function. Right hand had some pain with less than 40% function. 09/27/18: Day off from work. Same condition but right hand is getting worst by the hour. Pain med has no impact on pain. 09/28/18: Day off from work: Through the day both hands become more restrictive in motion and has severe pain. By later afternoon hands have less than 5% usage. Knees achy with ankles but mild. Pt went to ER. Received steroids and pain killer. Continued to have excruciating pain in both hands and wrists. Felt some relief within an hour but not much. 09/30/18: Day of work that was given off. Woke up with Left hand doing a good deal better and Right hand still painful but better also. Left hand had 50% function with Right hand at 25% function. He was happy with pain coming down to something manageable. As the day went on both hands got better with at least 75-80% usage to mild-moderate pain. 09/31/18:  Pain in both hands started off mild with good usage in the morning. As day was going on, he felt his get tighter and get worse with both hands. Other joints feel fine. No fever or chills since 09/26. 3 PM hands went back to minimal usage and a great deal of pain in both hands. Meds provided no improvement. By midnight back to severe pain again with 20% of usage in both hands. Left hand is a little worse than right hand. 10/01/18: Left hand worse than right with a lot of pain in both. More function returned to hand up to 30% left hand and 35% right hand. Looking for a doctor to see. 10/02/18: Got steroids, pain killer, and anti-inflammatory med. Instant relief with steroids. Pain returns at night. 10/03/18: Steroid works again. Best day so far, but still only 70% function use of both hands. Pain only when he is in certain positions. Pain returns at night once steroid wears down. 10/04/18: Last night painful. Awake with pain. Steroid working at noon. 70% function in both hands but pain is tolerable. 10/05/18: Went to doctor. Hands sometimes feel like they are feeling, but then at other times very painful. While at Doctor's office, he had use of hands and low pain. Doctor felt like patient can do work with some restrictions. 10/06/18: Awoke with hands feeling okay, but achy. As day goes on pain gets more painful by the hour. Pt takes steroid pills. The pain becomes manageable. At night a slow achy pain becomes to creep in again. He finds it tough to sleep. 10/07/18: Awake with minimal pain but has pain. Patient is staying on Meloxicam. He does not notice a difference in the pain like he did with a steroid. A day goes by pain increases. He ices and elevates with minimal effect. Night time is very painful again. Pain is at 5/10. 10/08/18: Wake up with pain. Calls into work to Off duty status. While at doctor office, they discuss 3 more days off to see if it improves. Still swollen on right wrist with pain. Left hand is painful but better. Pt seems to feel that he is healing but very slow. Dr. orders blood work for more answers. He will stay on Meloxicam and return to 11th for progress. 6 PM, situation seems to be improving. Slight pain but tolerable. Hoping time will subside the inflammation that is causing pain. Weakness could be a small issue due to immobility and guarding of my wrists. 12pm: Midnight and pt feels great improvement. Lots of flexibility and movement. 10/09: Woke up stiff right wrist but very little pain. Day is going by and for the first time, he feels like he can do tasks with his hands. He states that he has painful "cracks" in certain positions but almost has mobility back. He is 85% back to normal.