Post-Vaccination Severe Arm Pain and Weakness in Adolescent Patient
Case at a Glance
A 14-year-old female developed severe arm pain, weakness, and functional limitation following simultaneous administration of HPV, meningitis, and tetanus vaccines in the left upper arm.
Patient's Story
The patient received three vaccines (HPV, meningitis, and tetanus) simultaneously in her left upper arm during a routine immunization visit. Within one hour post-vaccination, she experienced a burning sensation in the injection site. Progressive symptoms developed over the following hours, including inability to fully lift her arm, weakness in her left hand affecting grip strength, and severe pain preventing her from lying on her left side. The pain radiated to her left collarbone and axilla. Twenty-four hours post-vaccination, the patient remained unable to perform activities of daily living such as dressing herself due to persistent pain and functional limitation.
Initial Assessment
Patient presented with acute onset of severe left upper extremity pain, weakness, and functional impairment following multiple vaccinations. Physical examination would likely reveal tenderness over the deltoid injection site, limited range of motion of the left shoulder, and possible weakness in the affected extremity. The patient appeared to be experiencing significant discomfort and was unable to use her left arm normally.
The Diagnostic Journey
Based on the temporal relationship between vaccination and symptom onset, along with the characteristic presentation of severe pain and functional limitation, the clinical picture was consistent with Shoulder Injury Related to Vaccine Administration (SIRVA). This condition typically occurs when vaccines are administered too high on the arm, potentially affecting the shoulder joint capsule or surrounding structures.
Final Diagnosis
Shoulder Injury Related to Vaccine Administration (SIRVA) following multiple immunizations
Treatment Plan
Conservative management was initiated including rest of the affected extremity, intermittent ice application (as tolerated), and over-the-counter anti-inflammatory medication (ibuprofen). Patient was advised to avoid activities that exacerbate pain while maintaining gentle range of motion as tolerated. Close monitoring was recommended with instructions to seek further medical evaluation if symptoms persisted or worsened after 2-3 days of conservative treatment.
Outcome and Follow-up
Patient was advised to follow up with the healthcare provider who administered the vaccines if symptoms did not improve within several days. Due to limited family support, alternative resources for medical care were discussed. The importance of proper vaccine administration technique was noted for future reference to prevent similar complications.