Atypical delayed onset (3 days after shot) of myalgias/arthralgias that lasted weeks - see attached - (1) patients typed listing (2) my dictation pm 12/19/11. In 2010, I received a flu shot on Nov. 7. A few days later - wham! - fine yesterday, but now severe aches and pains all over. Aches and pains stayed severe for a long time. Started taking full dose aspirin. Monday, Nov. 22 was the first day of my body feeling normal, but has some regression, even taking morning and evening full aspirin. I would have liked to stop taking the morning and evening full aspirin but never tried this, for one reason or another. In 2011, I received the flu shot on Oct. 23 and was fine until Thursday, Oct 27 when  - wham! Heavy aches and pains from the waist down. The pain was so bad I had problems climbing over crowd control thick velvet lines. The pain was so bad that for the first time I had a sports injury (tennis) to my left lower leg that I didn't know when/where it occurred. Only later did I find a long hurt area in the back of the lower leg and had swelling from above the knee to foot. There may have been some injury to the knee. The pain was bad enough that I didn't go after short or long balls, that in the past I would have chased down and returned. At this point there was uniform tightness in the legs above and below the knee. I was taking steps and going up and down stairs gingerly. Occasionally, feelings occurred that a knee wouldn't hold up, or would hurt, if I completed the step. The night of Nov. 17-18, I had the 24 hour stomach flu. (My wife got it even worse on Nov. 20-21). Before the flu I would say I was 35% recovered from whatever was going on. After the 17-18 flu, I would say I was 55% recovered. The pains became sharper, but there were fewer of them. I started wearing loose fitting knee braces during the day to keep the pain down and tight fitting knee braces for tennis and my "chasing ball" range started to increase. On Friday morning, Nov. 25, my legs felt normal going to and from breakfast in the hotel (no stairs). This regressed during the day. On Nov. 27, I noted that the tired leg feeling on going upstairs was gone. Coming down stairs had less knee pain. This meant I was 65% recovered, but there are good periods and bad periods around that point. As of Nov. 29, I am back to doing 75% of my routine daily exercises, but no running in place on the trampoline yet. My hope, of course, is for complete recovery to what passes as normal feelings in my body. From that point there has been gradual improvement until on 12.19 I am 85-90% improved. Now sharp pains around the knee area and not always in one area. Standing or sitting, there is still "nervous leg" feelings which make you want to change positions. Standing has stiffness in the front of the legs. Walking tends to bring back/increase pain. Going up stairs there is strain below the knee. Going down stairs there is strain on the knee. Sitting has a strain or pain above and below knee. Getting up from a chair has a strain or stiffness above and below the knee and brings pain back. Occasionally, while moving, there is a feeling in a knee that there will be a sharp pain or the knee will fail, so you pause in what you were going to do and proceed cautiously/gingerly. I had the pleasure of seeing this 78-year-old male for evaluation of reactions to the flu vaccines. In the year 2010 he received the flu vaccine and a few days later he had some onset of aches and pains that stayed for a few weeks and responded to aspirin. On 10/23/11 he received the flu vaccine again and four days later he had some onset of "heavy aches and pains" from the waist down. The pain is so bad that he stated it is difficult to determine if or where the pain in his left lower leg is was present from a sports injury that he had sustained shortly before the flu vaccine. He outlined well in the letter to me all of the symptoms that included pain and fatigue in the legs. Now he is about 90% back to normal but is still unable to run in place on the trampoline as he had in the past. He still has occasional sharp pains in the knee area and a "nervous leg" that makes him want to change positions. The symptoms are exacerbated by walking and going upstairs. Delayed Reactions to Flu Vaccine: This is a rather unusual delayed type reaction to the flu vaccine. It has happened twice in a row, more severe the second time so the history is convincing. There is no way to prove cause and effect relationship as there is no testing available for these delayed type reactions (If it was an immediate type reaction of urticaria/angioedema we could do skin testing but not for this type of reaction). I cannot predict whether this will happen in the future. The patient is understandably reluctant to try this again. I did suggest a compromise which would be using a preservative free vaccine to see if it is tolerated and he will consider that option for next year. He asked me to out a VAERS (Vaccine Adverse Event Reporting System) form to send to the CDC and I will do that for him.