Age: 51.0
Sex: F
Vaccine: VARZOS
Symptoms: Cough, Diverticulitis, Flank pain, Haemangioma of liver, Herpes zoster
Clinical narrative: Covid illness symptoms; Urinary tract infection; right lower quadrant abdomen pain, Sever pain (ER)/ exacerbated by position/movement, coughing, deep breathing, stretching/ sharp/ severity of 9/10; right flank pain; Right lower back pain; Herpes zoster, "Enteric zoster"/ hospitalized 1 day; 8-9 pustules on abdomen; Hepatic hemangiomas (abdominal pelvic CT angiogram); Pain; Diverticulitis (abdominal computerized tomogram); Symptoms disturbed her sleep; This case was reported by a physician via other manufacturer and described the occurrence of herpes zoster in a 51-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   Previously administered products included BNT162B2 (on 28 August 2020 at 11:30 received 1st dose intramuscular route at left deltoid when the patient was 49 years old), BNT162B2 (on 17 September 2020 at 14:51 received 2nd dose intramuscular route at left deltoid when the patient was 50 years old) and BNT162B2SA (on 1st April 2021 at 15:17 received 3rd dose(1st booster) intramuscular route at left deltoid when the patient was 50 years old). Concurrent medical conditions included restless legs syndrome (form 2004), asthma (from 1995) and seasonal allergy (from 1978). Concomitant products included TOZINAMERAN (BNT162B2), ropinirole and fluticasone propionate + salmeterol xinafoate (Advair).   On 12th June 2022, the patient received Shingrix (intramuscular) .5 ml. On 12th June 2022, less than a day after receiving Shingrix, the patient experienced herpes zoster (serious criteria hospitalization). On 14th June 2022, the patient experienced sleep disturbance. On 15th June 2022, the patient experienced diverticulitis (serious criteria GSK medically significant) and pain. On 20th June 2022, the patient experienced urinary tract infection (serious criteria hospitalization), lower abdominal pain (serious criteria hospitalization), flank pain (serious criteria hospitalization), low back pain (serious criteria hospitalization) and hemangioma of liver. On 14th August 2022, the patient experienced coronavirus infection (serious criteria hospitalization). On an unknown date, the patient experienced pustule. The patient was treated with ceftriaxone, ketorolac, morphine sulfate, ondansetron, methylprednisolone and valaciclovir. On 24th July 2022, the outcome of the herpes zoster, urinary tract infection, lower abdominal pain, flank pain, low back pain, diverticulitis, sleep disturbance, hemangioma of liver, pustule and pain were recovered/resolved. On an unknown date, the outcome of the coronavirus infection was recovered/resolved.   The reporter considered the herpes zoster, coronavirus infection, urinary tract infection, lower abdominal pain, flank pain, low back pain, diverticulitis, sleep disturbance, hemangioma of liver, pustule and pain to be possibly related to Shingrix.     Linked case(s) involving the same patient:  US2022AMR124217   Additional Information: GSK Receipt Date: 25-AUG-2022 Reporter's Comments: On 22 April 2022 patient also received 4th dose (2nd booster) of BNT162b2 at intramuscular route. The patient initially experienced mild unspecified symptoms on 12 June 2022. The event enteric zoster required emergency room visit. On 14th Jun 2022 the 2 days after vaccination the patient experienced symptoms disturbed her sleep and on 15th Jun 2022 was uneventful. On 15th Jun 2022, 3 days after receiving Shingrix patient experienced pain sever enough that patient missed her flight home and presented to the hospital emergency room. The only finding was diverticulitis without evidence of diverticulitis on abdominal computerized tomogram. The patient discharged form the emergency room. On 20 Jun 2022 the patient returned home and directly went to hospital emergency room. The patient was hospitalized for 1 day on 20 June 2022 and was discharged on 21 June 2022. The patient reported pain right lower quadrant (RLQ) abdomen, right flank and right lower back exacerbated by position/ movement, coughing, deep breathing and especially stretching her right side. The patient waxed and waned, was sharp and at it was worst had a severity of 9/10. On examination body temperature was 97.7 degree F, pulse was 77 beats per minutes, respiration rate was 28 RPM , blood pressure was 142/70 mmHG, oxygen saturation was 100 on room air, including abdominal exam without tenderness, guarding or rebound and normal skin exam. Notable labs were limited urine analysis with 3 pluse leukocytes esterase, 4-10 red blood cells (RBC/hpf) and white blood cells 21-50/hpf.  The pelvic USG was normal. The abdominal pelvic CT angiogram was negative for enteric arterial disease but did not reveal 2 incidental (NCS) hepatic hemangiomas. The abdominal magnetic resonance imaging was normal. The patient was admitted on hospital on 20th Jun 2022 and was received Ceftriaxone 1mg intravenous for her urinary tract infection and for her pain she received ketorolac 15mg, morphine SO4 4mg, ondensetron 4mg, methylprednisolone 125mg via intravenous route. The patient was responded to pain control and was discharged on 21 Jun 2022 with a diagnosis of RLQ abdominal pain, right flank pain and UTI. 8 days after receiving Shingrix patient experienced urinary tract infection, flank pain, low back pain and hemangioma of liver. The patient called couple of neurologist she knew and based on her symptoms and the temporal relationship of Shingrix vaccine, each had suggested enteric zoster as the diagnosis, but the hospital physician did not want to hear what she was telling them. Less then 3 months after receiving Shingrix patient experienced pustule.The patient developed 8-9 pustules on her right upper abdomen. On 14th Aug 2022 63 days after vaccination, the patient had Covid illness symptoms at that time reported her hospitalization. The patient did follow-up with her primary care physician wo started her 30 days course of Valaciclovir twice daily with resolution of her symptoms and confirmation of the neurologist diagnosis. The outcome of the event was recovered on 24 Jul 2022. Additional supportive information: The case has been linked with case US2022AMR124217 reported by same reporter.; Sender's Comments:  US-GSK-US2022AMR124217:Same patient, Reporter