Age: 70.0
Sex: F
Vaccine: VARCEL
Symptoms: Asthenia, Inflammation, Laboratory test abnormal, Muscular weakness, Nerve injury
Clinical narrative: Information has been received from an investigator concerning a 70 year old female with hypertension and a history of right hip replacement and hysterectomy for fibroids, who entered a study. On 4/20/06 the pt was vaccinated SC in the left deltoid area with a 0.65 ml dose of varicella zoster virus vaccine live. Concomitant therapy included estrogens, conjugated (Premarin), sulindac and Niferdine. On 6/10/06, 51 days after vaccination in the left deltoid area, the pt dropped a glass that was held in her left hand which was unusual for her. The next day on 6/11/06, she awoke with clear weakness in her left upper arm, especially in the biceps muscle. No shoulder pain or sensory loss was reported. The weakness continued over several days with the peak weakness occurring on 6/19/06. The weakness involved her proximal left arm. She reported a 2/5 strength in her left biceps and deltoid, however the triceps and grip strength were normal. No shoulder weakness or weakness elsewhere in the body was reported. No sensory loss was noted over the arm. No rash was reported on the arm or elsewhere. She saw her local physician the same day who confirmed the weakness. On 6/30/06 the subject noted a new onset of burning dysthesia over the dorsum of her left hand.  The burning sensation did not involve the palmer surface of the left hand. She reports the sensation fluctuates from almost gone to occasionally more noticeable. On 7/13/06 the pt saw a local neurologist who assessed the strength in the left arm as susprasinatus, infraspinatus, deltoid and biceps muscles 2/5 strength. There was 4/5 strength in the left triceps. All other muscles in the left hand and elsewhere were 5/5. There was no sensory loss to touch or arm pain. The pt had an EMG done which showed evidence of recent denervation of the deltoid and biceps muscles that is consistent with a left brachial plexus neuritis. The neurologist made the diagnosis of left brachial plexus neuritis and treated the pt with prednisone 50 mg QD for 3 days with a taper over 2 weeks. This did not change things. She was also placed on physical therapy which she was currently receiving. An MRI of the brachial plexus was done on an unspecified date, results pending. On 8/10/06 the pt reported no new complaints and felt her strength was slowly returning in her biceps, but not her shoulder. She reported not having any pain in the arm of shoulder or having sensory loss other than the burning sensation on the dorsum of the left hand. On 8/10/06 the pt had another EMG, results were pending but preliminary results were consistent with the diagnosis of left brachial neuritis but with a slight improvement. At the time of the report, the pt continues to make slow improvements in strength on the left upper arm muscle, but they are still weak. No rash developed or any other problem. The reporting investigator felt that left brachial plexus neuritis/left brachial plexitis was possibly related to vaccination with varicella zoster virus vaccine live. Left brachial plexus neuritis/left brachial plexitis was considered to be an other important medical event (OMIC). Additional information has been requested.