Age: 55.0
Sex: F
Vaccine: MMR, MNQ, PPV, MEN, MMR, PPV
Symptoms: Computerised tomogram abnormal, Injected limb mobility decreased, Nuclear magnetic resonance imaging abnormal, Pain in extremity, Periarthritis
Clinical narrative: On August 10, 2014 I attended the second day of an annual two-day event. I elected to receive 3 vaccines approximately 30 minutes before the event ended on August 10th.  I indicated that I wanted to receive the meningococcal vaccine, the measle-mumps-rubella vaccine and the Pneumovax. I had written these three vaccines on the intake sheet. I was informed that they had run out of the Pneumovax but they had the pneumonia vaccine that was given to children and it would be OK to receive that one. I was given the patient information sheets for  1) Pneumococcal Conjugate Vaccine  (2/27/2013), MMR Vaccine (4/20/2012) and Meningococcal Vaccines (10/14/2011). The nurse administered all vaccinations. The MMR was administered subcutaneously into the Right upper arm and the meningococcal vaccine into the Right deltoid muscle. I asked that the third vaccination not be given the Left arm because I am Left-handed but the nurse insisted that she had to administer this vaccination into in my Left upper arm (deltoid muscle) and did so. I experienced muscle tenderness and achiness in the left arm initially for about two weeks during which there was mild pain when I attempted to raise my left arm straight up in the air. The muscle tenderness, achiness and inability to raise my left arm straight up in the air or place my left hand behind my back continued for another ten days which I attributed to time spent in a cool, damp environment.  After leaving the cool, damp environment the muscle tenderness and achiness progressed to severe pain with the slightest movement of my left arm in any direction. The severe pain lasted through the month of September, approximately 30 days. The muscle pain and achiness gradually resolved over the next three months and was completely gone by January 2015; however, the inability to raise the left arm straight up in the arm, lift objects with my left hand above shoulder level or place my left hand behind back persisted. It was at this time that I inquired at the local County Health Department information about the vaccines that I had been given in August 2014. At first, January 30, 2015, no information regarding the site of administration or lot numbers was available for any of the three vaccinations because the information had not been entered into the Statewide Immunization System. On February 5, 2015, a fax of the intake sheet revealed handwritten lot numbers for the "pneumonia" vaccine [Merck J010396], MMR [Merck J013316 ] and an illegible sticker for Menactra with a handwritten lot # [44681AA]. The faxed intake sheet indicated that ALL immunizations were given in the right deltoid. Three physicians, a family medicine (03-11-2015), an internal medicine (03-23-2015) and an orthopedic surgeon (04-02-2015) were seen for the left upper extremity problem. Their comments were consistent: unable to abduct beyond 90 degrees, decreased range of motion, adhesive capsulitis, respectively, and all agreed no pain was elicited on examination.  All recommended physical therapy.