Received Jun 5, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| MENB | MENINGOCOCCAL B (BEXSERO) | NOVARTIS VACCINES AND DIAGNOSTICS | 1 | 75XF3 | IM / LA |
Patient is a 23-year-old female with May-Thurner syndrome and prior venous thrombosis on enoxaparin who presents with progressive left upper extremity numbness and weakness after vaccination. Two and a half weeks after vaccination at her last visit, she developed persistent soreness at the left upper arm injection site with numbness and tingling in the left arm starting 24-48 hours later. Symptoms have progressively worsened over the past 2 weeks. Paresthesias involve the entire left upper extremity from shoulder to fingertips, are constant, and are most prominent in the fingertips and palm. She notes decreased grip strength and hand control with frequent dropping of objects and is worried about safely holding her toddler. Her mother is here today for support. Pain is minimal aside from localized upper arm soreness. She has no pain with shoulder movement, no neck symptoms, and no symptoms in the right arm. She denies fevers and chills. She seeks evaluation due to persistence and progression of symptoms and concern about a possible vaccine-related reaction after reading that post-vaccine numbness can be concerning.
Family history of breast cancer in mother Long term current use of anticoagulant Chest discomfort May-Thurner syndrome Inferior vena caval thrombosis (HCC) Deep vein thrombosis (DVT) of iliac vein of both lower extremities (HCC) Raynaud's phenomenon without gangrene Tachycardia History of deep vein thrombosis (DVT) of lower extremity Postural orthostatic tachycardia syndrome Symptomatic hypotension Respiratory Seasonal allergic rhinitis due to pollen Hyperlipidemia Behavioral Health Current mild episode of major depressive disorder without prior episode Anxiety Obsessive-compulsive disorder Cyst of spleen Frequent UTI Posterior cervical lymphadenopathy Pyelonephritis Sepsis (HCC) Blood Rh negative, antepartum Nervous Migraine without status migrainosus, not intractable Syncope due to orthostatic hypotension Tremor Ear/Nose/Throat Acute non-recurrent maxillary sinusitis Sinus pressure Digestive Abdominal distention Blood in stool Gilbert's syndrome Heartburn Unprioritized Jaundice Medium Left lower quadrant abdominal pain Low Left upper quadrant pain Low Presence of Kyleena IUD Right upper quadrant pain Obstetrics/Gynecology 39 weeks gestation of pregnancy Endometriosis Irregular periods Genitourinary/Renal Dysuria History of renal calculi Orthopedic/Musculoskeletal Chronic midline thoracic back pain Lumbar strain, initial encounter Eye Scleral icterus Other Encounter for routine adult health examination without abnormal findings Family history of Gilbert's disease Fatigue History of sepsis
? busPIRone (Buspar) 15 mg tablet, Take 1 tablet (15 mg total) by mouth three times a day as needed (Anxiety). ? citalopram (CeleXA) 40 mg tablet, Take 1 tablet (40 mg total) by mouth every morning. ? enoxaparin (Lovenox) 40 mg/0.4mL inject
Allergies Codeine Drug Ingredient Hives, Rash, Anaphylaxis High Allergy 12/13/2015 Past Updates Penicillin Drug Ingredient Swelling, Rash High Allergy 10/8/2015 Past Updates Penicillins Drug Class Anaphylaxis, Hives, Rash, Swelling High 10/8/2015 Past Updates Other Reaction(s): Other (document details in comments) Sulfa (Sulfonamide Antibiotics) Drug Class Hives, Anaphylaxis High Allergy 12/10/2018 Past Updates
Adverse reaction to meningococcal vaccine with left upper extremity weakness and numbness Subacute left upper extremity weakness, numbness, tingling, swelling, and functional impairment after meningococcal B vaccination. Concern for local inflammatory reaction with possible nerve compression. Abscess or hematoma less likely due to no erythema, warmth, fever, or significant pain, but not excluded without imaging. - Started oral steroids. Took first dose as soon as obtained, then daily in the morning with food. - Counseled on steroid adverse effects including anxiety, insomnia, constipation, and gastrointestinal irritation. Advised adequate hydration. - Avoid further meningococcal B vaccination. - Discussed reporting adverse vaccine reaction to state authorities. Will review reporting requirements with office manager. - Go to ED if symptoms worsened or concern for serious complication. - Phone follow-up Monday to reassess symptoms. - In-person follow-up next Friday to reassess weakness. - If no improvement after steroids, proceed with further evaluation with ultrasound, CT, MRI, and or EMG nerve conduction studies as indicated. - Consider extension of steroid course pending clinical course.