Received Aug 12, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| RAB | RABIES (RABAVERT) | NOVARTIS VACCINES AND DIAGNOSTICS | 2 | FDP00552 | IM / LA |
5/12/25: pt vaccinated for rabies pep (dose #2) asymptomatic and well tolerated. RN provided care. 5/27/27: pt followed up for physical assessment with provider, FNP patient reports more Left Deltoid discomfort and decreased ROM d/t pain than previously experienced. She reports that at the time of vaccination, she experienced no uncommon discomfort and had full ROM and no tenderness. Over the weekend (5/24 and on) she started to feel more left deltoid pain. It decreased with rest and daily ibuprofen. During time of sx onset she was rafting and while the physical motion of rafting was not particularly painful, the following days left her with intense left arm pain and decreased ROM due to pain. She reported occipital HA, worse on left side that radiates up to scalp. Improved with ibuprofen, rest, hydration. She does have history of headache, but none as intense as the HA described recently. No central NS sx reported. While driving she experienced intense left arm sharp pain with radiation to head. This was brief, lasting seconds, and entirely resolved. On exam: there was no redness, swelling, or heat at injection site. Bandaid marking was in correct anatomical location for vaccination.Abd/Adduction exacerbates pain, but is possible. No apprehension against light force. Full ROM Of shoulder girdle, but with pain. No overt AC separation. Some muscular tension in left traps. Assessment: I suspected causes could be multifactorial and vaccination could contribute. Recommend rest, ice, ibuprofen 800 mg q8h x 1 week. Recommended f/u exam in 1 week if sx persist. I doubt AC separation or other ortho injury. In any case, rest and anti-inflammatories could benefit. One contributing factor to HA could be related to muscle tension in neck/shoulder in response to initial discomfort from vaccination. Could consider SSRI associated "brain zap" this was discussed with patient but not likely as pt has been on SSRI for 5 years with no recent dose change. Plan: hold off on vaccination in Left deltoid until sx subside. Recommend rest, ice and use body as guide; ie OK to run if sx not exacerbated by this; would not recommend heavy weight lifting, push ups,etc Follow up in 1 week if sx ongoing. Imaging or referral not recommended at this time.. The patient did not opt to follow up in person. I called her on 6/12/25 and she reported sx were ongoing but improved with ibuprofen 600-800 mg daily. She reported her headache had completely resolved. I recommended if sx ongoing to follow up with PT, PCP for arthopathy of left shoulder. Given timeline of sx onset and relatively benign exam, I discussed with the patient possible non-vaccine etiologies and encouraged PT/ PCP follow up. She has not requested follow up since a phone call I had with her on 6/16.
Question possibility of left shoulder arthropathy unrelated to vaccination
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