Age: 3.83
Sex: M
Vaccine: HEP, HIBV, MMR, PNC, VARCEL
Symptoms: Drug ineffective, Infection, Pain, Skin ulcer
Clinical narrative: Information has been received from a registered nurse concerning her 46 month old grandson with no pre-existing allergies or medical conditions who on 04-Dec-2000 was vaccinated SC in the left arm with a first dose of varicella virus vaccine live (Lot #635601/1148K) at about 15 months of age. Concomitant vaccines administered on 04-Dec-2000 included a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (Lot #633094/0177K) administered SC in the "right", a second dose of hepatitis B virus vaccine rHBsAg (Engerix-B) (Lot #5166A2) Im in the "left", a fourth dose of HIB conj vaccine (CRM197) (Hibtiter) (lot #473-003) IM in the "right", and a third dose of pneumococcal 4 6B 9V 14 18C 19F 23 F conj vaccine (CRM197) (Prevnar) (Lot #473-010) administered IM in the "left". It was noted the patient was not ill at the time of the vaccination and did not have adverse events following prior vaccination. On 11-Oct-2003 the child was seen by another health care practitioner and was diagnosed with shingles. No other information was available. The child was reported as recovered. Unspecified medical attention was sought. There was no product quality complaint. The VZVID program was declined because of the reporter was not the treating health care practitioner. Follow-up information received from a registered nuse (also the patient's grandmother and physician indicated that the rash did not occur at the site of injection or elsewhere within 42 days of the vaccination. The physician reported the date of adverse event onset was 10-Oct-2003 (also reported as 09-Oct-2003 by the registered nurse). The physician reported that the varicella zoster was diagnosedon 11-Oct-2003, on the left hand, and was treated with acyclovir 300 mg, 1 1/2 tablet TID for seven days. The herpes zoster "started at inside of the left hand between the thumb and the first finger and on the back of hand at the same site, then progressing up left arm". The patient was seen in the office on 14-Oct-2003 as the lesions had spread from his had up lower arm to distal half of left upper arm. The acyclovir was increased to 2 tablets TID for 10 days. Maximum temperature was 99.8 degrees Fahrenheit (also reported as 99/5 degrees Fahrenheit by registered nurse). The physician quantified the patient's patin as "0-1" on a pain scale (zero the least and 10 the most). The nurse, also the patient grandmother quantified the patient's patin as a 6 with most of the pain under his left armpit. There were no other systemic symptoms. There was no history of chickenpox. There was no recent exposure to chickenpox or herpes zoster. On 14-Oct-2003 a varicella zoster and herpes simplex antigen were collected. The varicella-zoster virus was positive by direct immunofluorescence and the herpes simplex virus was negative by direcet immunofluorescence. Photos were taken. The patient did not have a fever, "never actually ill", had no further spread of lesions after distal upper left arm and had no lymphadenopathy. The patient recovered on 17-Oct-2003. No additional information is expected.