Age: 28.0
Sex: F
Vaccine: HEPA, MNQ
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site vesicles
Clinical narrative: 07/16/2013, Monday: 11:50 AM:  time of vaccine administered- unusual pain of injection (could distinguish between Hep A vaccine to right arm and Meningicoccal vaccine to left arm, where left arm was more painful); 2:15 PM:  left arm muscle ache; Evening: Lethargic, tired, sickly, entire body sores.  Unable to move/raise/rotate left shoulder due to pain.  Redness and skin warmth (like map-shaped) located 5" below site of injection with a diameter of 1" by 2" (I will name this "map #1"). 07/17/2013, Tuesday: 1:00 AM:  temperature of 101.7 Fahrenheit, orally.  No chills. Treatment: Ibuprofen 800mg for fever reducer and pain reliever; Morning/ afternoon:  Slept all day.  Unable to move/raise/rotate left shoulder due to pain.  Map #1 increased in diameter from 1" by 2" to 2" by 4"; Evening:  Additional redness and skin warmth appeared between previous map #1 and site of injection with a diameter of 1" by 3" (I will name this "map #2"). Both map #1 and #2 indicated increased elevation/ swelling of arm.  Remains warm to touch and painful.  Arm- immobilized due to pain; Night:  Tried to sleep off the pain.  Treatment:  Motrin 400mg; 07/18/2013, Wednesday:  2:30 PM:  Follow-up with Dr. (same facility, different doctor) who prescribed Amoxicillin 125 mg PO twice a day for 10 days and Prednisone 20 mg PO twice a day for 4 days, and was given a Doctor's Note to excuse from work on 07/19/2913. 9:00 PM:  Drank medication.  Treatment:  Amoxicillin and Prednisone (first dosages). 11:00 PM:  The color of map #2 was no longer red but now dark purple with increased sign of elevation/swelling. Remains warm to touch, sensitive, and painful. 07/19/2013, Thursday:  Fever reduced. Map #1 started decreasing in diameter.  Map #2 remained visibly dark purple. Center of map #2 started forming a blister.  Increased mobility of shoulder/ arm.  Remains warm to touch, sensitive, and painful. Evening/Night:  Blister of map #2 encompassed 1/3 of its surface area. 07/20/2013, Friday:  Blister of map #2 encompassed > 80% of surface area with approximately >5mL of fluid.  Covered with 4" by 4" gauze to prevent infection/exposure. 07/21/2013- 7/23/2013:  Blister of map #2 encompassed > 90% of surface area with approximately >5mL of fluid.  Covered with 4" by 4" gauze to prevent infection/exposure. Treatment:  Amoxicillin twice a day PO. Finished Prednisone by 9:00 AM of 07/22/2013. 07/23/2013:  Visited urgent care for possible drainage, antibiotics ointment prescription, and second opinion of failed intramuscular method of vaccine injection.  Dr. of urgent care suggests not draining blister and letting my body re-absorb fluid.  Nurse supervisor suggests that the route of vaccination was subcutaneous (not intramuscular, IM) and location of injection was approximately 2" below normal site of IM injection. 07/24/2013:  Fever relieved by Amoxicillin antibiotics (will complete on 07/28/2013).  Swelling of left arm relieved by Prednisone steroids (completed on 07/22/2013).  Blister of map #2 is filled with >5ml of fluid with a diameter of 1" by 1.5", dark purple color visible, and is sensitive/painful to touch.  As of 08/01/2013:  Finished amoxicillin treatment.  No visible swelling.  Not feverish.  Applies silver sulfadiazine 1% cream twice a day as prescribed by managing Dr. Covers with non-adhesive gauze.  Fluid from blister was reabsorbed to my body.  Dark purple skin color (burnt like effect) is starting to peel.  Bottom of blister is fresh pink.  Site remains itchy and at times, painful.  Not sensitive to touch.