Age: 47.0
Sex: F
Vaccine: TD
Symptoms: Tremor
Clinical narrative: On 4/28/00, 2-3 hours post vax, the pt experienced a mild stiffening feeling in the muscle of left forearm. The following days, 4/29 and 4/30 the pt was weak, nauseous, short of breath, stayed in bed most of the time. Painful to lift left arm. Called MD, was told this sometimes happens, should improve, call back if worsens. Pt was much better by 5/1/00. On 5/3 or 5/4, the pt experienced stiffening in left forearm mostly before bed and upon waking. Occasional weakness and aching in both arms. A tendency in the left forearm to want to freeze into stiff position. This continues off and on until 6/26/00. On 5/17 and 5/18, a burning pain in the muscle on back right side of neck, stiff neck, could not turn to right. Continued for one full day. Next day, the pt experienced a sun burn feeling in that area. On 5/23 and 5/25, the pt experienced the same symptoms as on 4/29 and 4/30 except both arms are weak but can be raised over head. On 6/5/00, the pt had a doctor appointment. Blood work was ordered. 6/7/00 - brief severe nausea for 15-30 minutes. Mildly weak feeling and mildly nauseous rest of day. 6/8/00 - antsy feeling, stopped all caffeine. 6/11/00 - the pt states "want to climb out of my skin, hardly sleeping. Stopped taking my synthroid." on 6/12/00 diagnosed with hyperthyroid. On 6/16/00 continued restlessness, insomnia and nighttime episodes of burning and weakness in arms and chest. Diagnosed with menopause. 6/17/00 throat felt tight, uncomfortable to talk, short of breath. 6/18/00 pt went to ER due to severe cramping of diaphragm, stomach and surface abdominal muscles, severe burning sensation and tightness in throat, short of breath. Severe burning in left pectoral muscle (under left breast). Severe burning across back below shoulder blades. Cramping intense and constant. Extremely thirsty. Burning and cramping are both intense and constant. No diagnosis, but black widow spider suggested. Given valium, Benadryl and discharged. On 6/21/00, woke from deep sleep at home with crushing pain in center of chest, shoulders pulled forward, profound pain and weakness radiating down both arms and neck, shortness of breath, initially too weak to move then able to get up, teeth chattering, sensation of warmth then cold in arms, very dry mouth. Event lasts about one hour then went to a local heart hospital. EKG normal. On 6/24/00, pt experienced chills. On 6/25 when going to sleep had lower surface abdominal cramping, severe burning in tail bone, pins and needles feeling on surface of abdomen, mile burning and twitching in both calves. 6/27 and 6/28, the pt is sore and tired everywhere. Numbness in front of throat and back of tongue. Difficult to talk. Slow waves of pins and needles everywhere when at rest. 6/29/00, numbness in left arm and ring finger and little finger in left hand. Tremors in head and limbs, headache, went to ER pulse is 100. on 7/1, 7/2 periods of mild burning in arm and down back. Very antsy, and thirsty. 7/3 very drained, tired in bed most of day sleeping. A little dizzy with mild nausea. Mild headache, pulse 78. 7/4/00, weak, tired, but a little stronger than day before. In bed most of day, eating more normally.  A follow up report received 8/3/2000 adds: Records received from pt 7/21/2000 re outpatient ER visits: 6/23 DGx-nonspecific chest pain, 6/18 muscle spasms unknown cause, 6/29 neuropathy of unknown etiology. 8/3/2000 received record from this primary care MD. Her progress note of 6/28/2000 indicates that symptoms being resolved and the etiology is unknown. She has agreed to a neuro and allergy consult. Case is complete. Will add and forward any additional records pt may choose to send.