Age: 66.0
Sex: F
Vaccine: PPV
Symptoms: Injected limb mobility decreased, Loss of personal independence in daily activities, Pain, Pain in extremity
Clinical narrative: 1.    ARM PAIN AND IMMOBILITY.   On 8/17/2020, I received the Pneumovax 23 vaccine in my right arm by injection around 8:30 a.m. at my PCP?s office by his nurse.  Within 2 hours of receiving the vaccine, my right arm started feeling like it had a crick or catch in it.  I stretched my arm but the crick was still there.  Over the next 2 hours, my right arm became sorer, eventually becoming very painful.  By noon (~ 4 hours after injection), my entire arm was in excruciating pain and if I even attempted to move it, the pain was so severe it literally brought tears to my eyes.  (I have a high tolerance to pain, so when I say the pain was excruciating, it really was!)    My PCP?s office was closed for lunch and I left a voice message for the nurse.  In the meantime, I called my local Pharmacy and spoke with the pharmacist.  He said to take Tylenol.  The pain was so great that at some point I started taking hydrocodone that I had on hand.  Around 2:00 p.m. the PCP nurse returned my call, I explained the problem, she consulted the Dr. and called me back.  She said they were not aware, and had never heard, of this happening before.   The nurse (and I) was very thankful that the injection was in my RIGHT arm, otherwise we both would have thought I was having a cardiac event!  Same day, the excruciating pain continued, the pain meds were not effective.  To get out of bed and go to the bathroom, I had to ?hug? my right arm with my left hand/arm to keep it as still as possible.  The pain extended down my right arm to just above my wrist.  I could wiggle my fingers and flex my hand without pain.  The pain also started to go up into my right shoulder and right upper back.  By around 6:00 or 7:00 p.m. (~10 hours after injection), the pain in the right shoulder/upper back stopped progressing.  Over the next 24 hours, the pain very slowly started retreating.  It took several days before I could use my right arm well, e.g., motion was limited, had trouble brushing my teeth, putting on clothes, etc.  By about day #9, I was finally able to pull on/pull off tight-fitting clothes over my head.  At 2 weeks after injection, my arm was back to about 98%.  IMPORTANT to note that the focal point of the pain was/is NOT at the injection site (which was more on the back side of my upper right arm).  The focal point of the pain IS, and STILL IS, around on the FRONT side of my upper right arm.  The injection site never got red nor warm.  I had no fever.  To this day (1/6/2021), over 4 months later, I still have the ?pain? at this focal point when doing certain things.  For example, sleeping on my right side, trying to scratch or wash my back, and moving my arm in various directions.  I?ve tried massaging it myself assuming the pain is muscle-related, but that just made it worse.  As I write this, the pain definitely has not lessened, if anything, it?s gotten a little bit worse ? meaning I?m experiencing it more often.  If you have any suggestions on how to get this pain to go away, I?d really appreciate it!  I assume it?s muscle-related, but I suppose it could be nerve-related. ??  2.    HOT FLASHES.  At the same time (on 8/17/2020) that my right arm was becoming more painful and immobile, my post-menopausal hot flashes ramped up.  For the past many months, my hot flashes had been mild to moderate; on this day (8/17) they became horrendous (i.e., severe), reminiscent to when I first experienced hot flashed around age 52).  These hot flashes come on suddenly, last a couple of minutes, and oddly enough repeat about every 40 minutes.  (It was uncanny, I could almost set my watch by these hot flashes!)  As I write this over 4 months later (1/6/2021), the hot flashes are still bad, and still come fairly regularly.  NOTE (A):  FYI, I was prescribed Rx Colestipol (took 8/4/20-9/21/20) for ?stomach irritation?, but it didn?t help.