Age: 59.0
Sex: F
Vaccine: VARZOS
Symptoms: Scab, Skin fissures, Vaccine positive rechallenge, Weight bearing difficulty
Clinical narrative: couldn't even stand or bear weight; Difficulty in standing; Pain in back of leg; Groin area pain; couldn't even extend her right leg to drive; Feeling pain; deep nerve pain; Skin break; Tingling/ pins and needles feeling; Hyperesthesia; could not sit in a normal position; felt crummy; felt like she was coming down with something; skin scab; Muscle aches; Flu like symptoms; Soreness at injection site; This case was reported by a other health professional via call center representative and described the occurrence of pain in a 59-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   The patient's past medical history included shingles (had an active case at 35 years old), appendicitis, abdominal pain, neuralgia (post neuralgia pain ) and skin lesion (dermatome). Previously administered products included Shingrix with an associated reaction of myalgia (For tolerance to 1st dose refer case US2019AMR125734) and acyclovir.   On 9th May 2019, the patient received the 2nd dose of Shingrix (intramuscular) .5 ml. On 5th June 2019, 27 days after receiving Shingrix, the patient experienced pain, nerve pain, muscle pain, leg pain, groin pain and mobility decreased. On 7th June 2019, the patient experienced weight bearing difficulty and difficulty in standing. In June 2019, the patient experienced skin fissure, tingling, hyperesthesia and posture abnormal. On an unknown date, the patient experienced scab, influenza-like symptoms, injection site pain, feeling bad and feeling unwell. The patient was treated with ibuprofen, gabapentin and naproxen. Rechallenge with Shingrix was positive. On an unknown date, the outcome of the pain, skin fissure, tingling, hyperesthesia, scab, muscle pain, influenza-like symptoms, injection site pain, feeling bad and feeling unwell were recovered/resolved and the outcome of the nerve pain, leg pain, groin pain, mobility decreased, posture abnormal, weight bearing difficulty and difficulty in standing were unknown.   It was unknown if the reporter considered the pain, nerve pain, skin fissure, tingling, hyperesthesia, scab, muscle pain, influenza-like symptoms, injection site pain, leg pain, groin pain, feeling bad, mobility decreased, posture abnormal, weight bearing difficulty, difficulty in standing and feeling unwell to be related to Shingrix.  Additional details were provided as follows: In June 2019, the patient did trail work for 5 days and she was used to this sort of thing. The third or fourth night she started feeling a little bit of pain in the back of her right leg, like sciatic nerve distribution and could not really sit in a normal position. It was difficult to sit and be in a squatting position, with lower right limb pain. At the end of the week, she could not even extend her right leg to drive. She has never had this pain in her life. It kept getting worse.  The patient just felt like it was shingles, because it was a deep nerve pain. Then she went into an urgent care that weekend and was told to take IBU 800 mg three times a day and if not better in a week come back for an MRI. She went to a doctor two more times and was told she had to go to physical therapy.  They did not know what was wrong because of how it was presenting. The pain kept moving around in the whole right leg.  The groin area, gluteal muscles and back of her leg to her foot. It was not responding to any anti-inflammatory drugs. The last time she went to the doctor they gave her gabapentin and that allowed her to sleep at night. The pain was not as bad during the day, but at night it would get horrible it would wake her up. When she went to the doctor the final time, she asked if there was any chance it could be shingles and the doctor said she would have skin lesions by now. However, the fourth week, she had one little tiny skin break in the front groin area. It was sensitive and had some pins and needles feeling. Feeling like it had some hyperesthesia and kind of tingling like something was going to happen. She never had an MRI to rule out an issue with her disc, but she did another week of hard labor since then and nothing.  On 5th June 2019, was when she started to kind of feel something. On 7th June 2019, 29 days after receiving Shingrix, the patient could not even stand or bear weight while even on the toilet.  On 8th June 2019, when she was first seen at the urgent care. The pain was mostly gone by 27Jun2019, but with a few more occurrences with leg aching at night. Otherwise, there is some residual ache in the leg.  Between 21st June 2019 to 27June 2019, she took gabapentin 300 mg, as well as Naproxen, which really helped. She has only taken it one more time since then, on 3rd July 2019.   This was when she noticed the skin break, which had a scab on it by then. Three to four days later it was gone. Also, following both doses of the vaccine, she had 24 to 48 hours of feeling pretty achy, had muscle aches, flu-like symptoms, soreness at the injection site, felt crummy and felt like she was coming down with something. These resolved after 48 hours. Historically, she had an active case of shingles at 35 years old. It was a typical case, right sided maybe the L4-L5 S1 dermatome skin lesions. She also experienced really deep right lower abdomen pain and thought she had appendicitis. She went to the doctor and was put on acyclovir or something for a week and then never really had any post neuralgia pain.