Received May 30, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| TDAP | TDAP (BOOSTRIX) | GLAXOSMITHKLINE BIOLOGICALS | UNK | PG3RP | IM / LA |
On 5/28 patient received Tdap vaccine. Patient seen in clinic on 5/29/25 for worsening pain in her left shoulder. Felt ok initially, but had progressive discomfort through the day. Limited range of motion, pain 9/10. Patient very tender over area of injection, guarding. Pain with resisted RTC testing and weak with sharper pain on abduction and external rotation. Does not tolerated impingement testing. Diagnostic ultrasound performed by provider: Long and Short axis view of the biceps shows no tear of the tendon without fluid in the sheath and negative subluxation. AC joint appears normal in long axis. Pectoralis major tendon in long axis is intact. Short and long axis view of the subscapularis shows no tear of the tendon and no subcoracoid bursitis or impingement. Short and long axis views of the supraspinatus shows tendinopathy of the tendon. With dynamic resistance testing there is no retraction of the tendon. There is no significant subacromial bursitis. Short and long axis views of the infraspinatus shows no tear of the tendon. With dynamic resistance testing there is no retraction of the tendon. There is no joint effusion and GH joint appears normal. Evaluation of the posterior labrum shows no tear. Impression : Diagnostic ultrasound of the left shoulder with findings supporting accidental vaccine administration into the supraspinatus tendon as a contribution to the patients pain and dysfunction. ASSESSMENT & PLAN 1. Shoulder injury related to vaccine administration (SIRVA) meloxicam (MOBIC) 15 mg tablet She has significant pain and dysfunction in her shoulder following vaccine administration yesterday. Based on location of bandage and hypoechogenic focus in the supraspinatus tendon in concert with her symptoms and physical exam, it appears that there was inadvertent administration of the Tdap booster into the subacromial space instead of IM into the deltoid muscle belly. Follow up in 2 weeks with me at Ortho. We will plan for xrays at that time if needed. May consider repeat US of shoulder. May consider referral to PT.
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5/29/25- diagnostic ultrasound of left shoulder