Age: 1.25
Sex: F
Vaccine: DTAP, FLU3, MMR, VARCEL
Symptoms: Decreased appetite, Herpes zoster, Injection site rash, Irritability, Laboratory test
Clinical narrative: Information has been received from a registered nurse concerning a 22 month old female with no pertinent medical history or drug reactions who on 16-DEC-2008 was vaccinated subcutaneously with the first 0.5ml dose of VARIVAX (Merck) (lot # 660567/0320X, site of administration not reported).  There was no concomitant medication.  On 12-AUG-2009 the patient's mother called the office and stated that while on vacation she had taken the patient to a physician since she had developed a rash on the upper right arm, chest and radiating around the back in a linear pattern.  The physician there stated the patient had developed shingles.  On 21-AUG-2009 the patient was then seen by another physician and was diagnosed of shingles.  No laboratory diagnostics studies were performed.  At the time of this report, the patient was recovering from shingles.  Follow up information has been received from a physician concerning the 22 month old (also reported as 23 month old) female patient with no known allergies who on 16-DEC-2008 was vaccinated subcutaneously with the first 0.5ml dose of VARIVAX (Merck) (lot# 660567/0320X) into the right arm.  There was no concomitant medication.  The patient had no recent exposure to chickenpox or shingles.  On 12-AUG-2009 the patient developed shingles on her right chest, deltoid and back for 3 weeks.  The rashes were papulovesicular in a dermatomal distribution.  There were more than 100 lesions.  It was reported that the patient's pain was a 3 or 4 on a scale of 1 to 10.  The patient had no fever or other systemic symptoms.  There was no rash that occurred at the site of injection post-vaccination.  There were no photos taken.  On an unspecified date, the patient recovered.  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) VZV strain or with the Merck vaccine strain.  A lesion sample was collected on 28-AUG-2009.  The sample was taken from residual scale.  The patient was already in healing stages and no vesicles remain at the time of collecting sample.  On 31-AUG-2009 the sample was sent to the laboratory.  PCR analysis of the specimen revealed it was inadequate (negative for beta-globin, no strain ID).  Follow up information has been received from a physician concerning the 22 month old female patient who on 16-DEC-2008 was vaccinated with a 0.5ml dose of VARIVAX (Merck) (lot # 660567/0320X) into the right arm.  Concomitant vaccinations on the same day included a first SQ dose of MMR II (lot # 661726/0917X, rHa) into the left arm, a fourth dose of DTAP (lot # C2952AA) IM into the left arm and the second dose of FLUZONE (lot # U72787AA) IM into the right arm.  There was no illness at the time of vaccination and no adverse event following prior vaccination.  There was no rash at the site of injection or elsewhere within 42 days of the vaccination.  On 12-AUG-2009 the patient developed over one hundred papulovesicular lesions in clusters in the right chest and upper arm in a dermatomal distribution.  The patient also had mild decreased appetite and was whiney.  The patient's pain was rated a 4 on a scale of 0-10.  There was no fever.  At the time of the report, the patient had recovered.  The PCR result was noted to be an insufficient specimen.  Additional information is not expected.