Received Jan 12, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (UNKNOWN)) | UNKNOWN MANUFACTURER | 1 | 3052583 | IM / LA |
Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Medium, Site: Shoulder Joint Injury (prolonged pain, tingling, etc.)-Medium, Additional Details: FLU AND COVID VACCINES ADMINISTERED IN LEFT ARM ON 12/13, PATIENT REPORTED SYMPTOMS STARTED ON 12/18, PATIENT REPORTED SIRVA AND BURSITUS DIAGNOSES ON 12/24, PATIENT REPORTED IMPROVEMENT IN SYMPTOMS ON 12/31/24 PATIENT IS NOT ON ANY MAINTENANCE MEDICATION, COULD NOT RELIABLY IDENTIFY PCP. MOST RELEVANT MD CONTACT MAY BE [name withheld] AN ORTHOPEDIC SURGEON WHO WAS SEEN ON 12/24/25 AND PRESCRIBED NAPROXEN FOR PAIN., Other Vaccines: VaccineTypeBrand: FLUCELVAX; Manufacturer: SEQIRUS; LotNumber: 410515; Route: INTRAMUSCULAR; BodySite: LEFT ARM; Dose: 1; VaxDate: 12/13/2025