Age: 53.0
Sex: M
Vaccine: TD
Symptoms: Discomfort, Injection site erythema, Injection site pain, Injection site swelling, Joint range of motion decreased
Clinical narrative: The pt has a background history of diabetes mellitus diagnosed in 1994. He took an oral hypoglycemic agent for perhaps a year after the initial diagnosis was made in 1994. He then either was taken off that medication or went off the medication and his diabetes mellitus was treated with diet alone until he saw MD on 6/17/02, at which time his hemoglobin A1c was noted to be 11.3% and he was placed on glipizide. He takes no other medications. He has no known medication allergies. He denies a history of hypertension nor cardiac disease. He has no history of cancer. He feels that his general health has been good. The pt states that following the injection he had some local erythema and swelling at the injection site in the left deltoid. There was associated aching discomfort over the lateral aspect of the left upper arm for several days. The swelling and erythema resolved, but he continued to have a low-grade aching discomfort over the lateral aspect of the left upper arm. The pt went about his business, but this discomfort over the lateral aspect of the left upper arm persisted and the pt began to notice some weakness in the left upper extremity. The pt states that the weakness in the left upper extremity has been getting progressively worse since the end of January of this year. He states that his grip is good, but he has difficulty raising his left arm. He can pick up things with his left hand, but he cannot brush his hair or brush his teeth because he cannot raise his left arm up to do so because of weakness. He has a pressure, aching type of pain over the lateral aspect of the left upper arm. He has no pain below the elbow. He has no neck pain. He has no cough or sneeze pain. He has no radicular type pain into the left upper extremity. He denies any neurogenic bowel or bladder dysfunction. His weight is stable. His appetite is normal. He denies any symptoms in the right upper extremity or either lower extremity. He denies numbness, tingling, paresthesias, or neuropathic type of pain. He denies dysarthria, difficulty chewing or swallowing. He denies diplopia. He denies ptosis. He denies cramps. When I asked him about muscle twitching, the pt was not aware of muscle twitching, but his wife comments that she has noticed his muscles twitching and she points to the left triceps muscle as the location of the twitching. She has not noted twitching muscles anywhere else. The pt does not smoke and never did. He does not drink alcohol. He denies any other neurotoxic exposure. There is no family history of similar problems. Impression: probable left brachial plexopathy, a variant of neuralgic amyotrophy. This type of syndrome can certainly occur following an immunization, but I would not expect it to be continuing to progress this long out from the time of the immunization if indeed he is still continuing to get worse. Acknowledgement letter states: Adverse event onset date and time 02/19/2003. Pt states his arm was sore after the shot and continued to be sore as the evening progressed, but it was the next morning that the soreness became painful and he experienced some weakness. He states he received the injection in the pm which progressivley worsened. Pt states that at this time he is unable to raise his arm