Age: 65.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash pruritic
Clinical narrative: Information has been received concerning a 65-year-old female with hypertension, hyperlipidaemia, "stenosis", a recent pulmonary embolism and deep vein thrombosis, "stable pulmonary nodules dating back to 2002, abdominal adhesions, nephrolithiasis, chronic fatigue, an allergy to eggs and TORADOL, environmental allergies, a history of left circumflex angiogram in 1997, back surgery, colostomy, hysterectomy and a "breast cystectomy bilateral" who on 06-NOV-2007 was vaccinated subcutaneous in the left arm with a dose of ZOSTAVAX (lot # 658602/1080U). Concomitant therapy included UROCIT-K, RESTORIL, LYRICA, allopurinol (MSD) and LASIX (started 06-NOV-2007). In November 2007 (a few days after receiving vaccine, the patient developed a pruritic flat rash located on the inner upper arms and lower forearms. It was reported that heat aggravates the rash. The patient was seen by a physician assistant on 19-NOV-2007 and was given prednisone and told to put on cool compress. No diagnostic labs were performed. At the time of reporting the patient's status was recovering. A product quality complaint was not involved. The patient was enrolled in the Varicella Zoster Virus identification Program to identify if VZV is present and if it is present to identify if it is associated with the wild-type (WT) strain or with the OKA/Merck vaccine VZV strain. Additional information has been requested. 02/10/2010 Follow-up: On 14-NOV-2007 at 11:20 the patient called her physician about a reaction to shingles vaccine., having hives on arm and belly. The physician spoke with the patient regarding the above and advised patient that a rash is common 7-14 days after giving live vaccine. Patient will use Benadryl for the itching and if no improvement by Friday needs follow-up appiontment. On 19-SEP-2007 the patient was seen for evaluation of possible reaction to shingles injection she received on 06-NOV-2007. Patient states rash started a few days after receiving an injection as a pruritic flat rash noted within the inner upper arm and lower forearm. No change ins soaps, detergents, medications or environment. No one else at home affected. Patient has been using Benadryl and cortisone over the counter to help with itch. Patient denies shortness of breath for chest pain. Denies headache sore throat or nasal congestion. Denies swelling or edema in the hands. Appetite normal sleeping well. Rash initially began upper arm spreading down to the mid foreamrs. No spread, recent regression noted on left arm. Patient reports various sensitivities to medications. Heat aggravates rash/puritis. Temperature 97.6 skint with fine lacy/rash noted in aspect of left and right upper arms spreading to mid left forearms. Dorsum not affectd. No rash of axilla neck, head posterior chest or lower extremeities/abdomen noted. Rash does not branch, no excoriation, no ulceration. Non specific pruritic drmatitis. The patient was treated with prenisone 20mg every day for 2 days then 10mg daily for two days. Cool compress, monitor for worsening symptoms. Photos of rash obtained today. Update at end of week. Call with any worsening symptoms. On 27-NOV-2007 the patient was evaluated for sensitive reash noted right upper arm outer aspect. Symptoms times 3 days.  Please see previous note regarding possible reaction to ZOSTAVAX. Patient states improvement of rash on left arm Still some residual on right arm but it is fading. Patient states right arm upper outer aspect is ver sensitive to touch, some pruritis. At night she feels very uncomfortable of the upper arms bilaterally and has a pins and needles and fire and feeling along the anterior axilla. Patient denies fever or chills. Patient only tolerated 1 1/2 doses of prednisone. Patient denies chest pain at this time. No change in medication, environment soaps or lotions. Temperature 97.6 blood pressure 148/168. Left arm without rash inflammation or swelling. Right arm with ill defined 4 1/2 x 3 cm oval lesion right upper outer arm. No vecular formation NO ulceration. Area is sensitive to pressure. Minimal redness noted. No axillary pain. No ther area of rash noted on face and neck or abdomen/chest. Increase (LYRICA) 50 mg a.m. and 100 mg "hs" for one week. ELOCON cream twice daily to affected area. Monitor for redness selling fever chills etc. Patient voiced understanding. Additional information has been requested.