COVID-19 arm: An unexpected vaccine reaction

July 9, 2021 / By Pamela Ewing, CPC

Waiting in the line of cars at the Biloxi Coliseum for my COVID-19 vaccine, I felt a sense of relief to be wrapping up my second dose of Pfizer vaccine. I was grateful for all those who worked so hard to get the drug out to the masses and for the men and women of the National Guard administering the vaccine to us on this day.

The parade of cars was as organized as a synchronized swim team, with six lines of cars wrapping around the Coliseum, eventually condensed into four lines with doctors at the end of each line to administer the vaccine.

Once vaccinated, we were told to pull forward and wait 15 minutes to make certain there were no ill effects from the shot. This being my second inoculation, I really had no fear of an adverse reaction. I felt okay. My arm was a tad sore and over the next few hours I was a bit tired and had a slight headache. All in all, it was a benign event just like my first dose of the COVID-19 vaccine.

Then, on the evening of day nine after the second dose, I noticed a small strip of skin under the injection site that was really hot and getting itchy. Other than the close proximity to the injection site, I didn’t think it was related to the vaccination. I just figured perhaps while outside I was stung or bitten by an insect and in my haste didn’t notice the bite.

Upon waking the next morning, I rolled over to turn off the alarm and felt an immediate burning sensation on my upper arm. A well-formed, large rash had appeared and I knew it couldn’t be ignored any longer.

I thought, “what in the world is this?” but I did my best to go about my day as usual, going into my office to start the workday. By noon my arm was itching and every scratch caused an intense burning sensation. It crossed my mind that this could be a reaction to the vaccine, but I dismissed the thought. I surely would have seen the reaction within the first 15 minutes or certainly within 24-48 hours of receiving the dose.

So, I embarked on a self-diagnosis adventure, which is never advisable.

“I wonder if it is shingles?” I asked a friend. No, it really doesn’t look like shingles and it definitely doesn’t hurt as badly as what I have heard having shingles feels like. I had also never heard of shingles starting on the upper arm and running in a downward pattern. So, I decided the best plan was to seek the opinion of a trained medical professional.

The doctor reviewed my medical history and the reason for the visit. She asked a few pertinent review of system questions, then she asked how many days it had been since my last dose of the COVID-19 vaccine. I responded one week and two days, which lead the doctor to my diagnosis: COVID-19 arm.

The CDC describes COVID-19 arm as a rash that erupts after administration of the COVID-19 vaccine. In my case, it was a delayed cutaneous hypersensitivity.

• COVID-19 arm usually occurs 2-12 days after the vaccine is given.
• COVID-19 arm typically occurs after the first dose and can occur again after second dose, or it can happen after the first dose and not second. In my case, I only had the delayed reaction after the second injection.
• The skin is pruritic and consistent with painful erythematous skin
  Pruritus – defined as an unpleasant sensation that provokes the desire to scratch.
  Erythema – is a type of skin rash caused by injured or inflamed blood capillaries. It usually occurs in response to a drug, disease or infection.
• The rash can increase in size and intensity of pain, causing additional aggravation and concern.

The doctor explained the condition could last up to 5 days and I was given a prescription for Zyrtec.  

I was pleasantly surprised that this itchy, hot rash called COVID-19 arm was gone in two days. In my mind, this minor nuisance was a small price to pay in order to be vaccinated against the COVID-19 virus. I had never heard of COVID-19 arm, but it happened to me. Stay vigilant and get vaccinated!

Pamela Ewing, CPC, CLA, is a coding analyst for 3M Health Information Systems.