Age: 1.03
Sex: F
Vaccine: MMR, PNC, VARCEL
Symptoms: Pruritus, Rash vesicular, Skin lesion, Viral DNA test positive
Clinical narrative: Information has been received from a physician concerning a 36 month old female with no pertinent medical history who on 16-AUG-2006 was vaccinated subcutaneously in the right thigh with a dose of VARIVAX vaccine (Oka/Merck) (Lot # 4650235/1110R). On 25-AUG-2008 the patient developed a zoster like rash with vesicles on anterior chest and a few laterally all on the same dermatome. At the time of the report, the patient was recovering from the events. The patient was seen in office. Follow-up information was received on 15-SEP-2008 from a medical record from a physician concerning a 3 year old female with occasional otitis media who on 16-AUG-2006 was vaccinated subcutaneously in the right thigh with a first dose of VARIVAX vaccine (Oka/Merck) (Lot #650235/1110R). On the same day she also received the first dose of MMR II (Lot #653484/0254F) in the right thigh and pneumonia poly (Lot #B08657K) in the left thigh. On 26-AUG-2008 the patient was brought to the physician's office by her father with 15-20 skin lesions over the left side of the chest on the back which had been there for the last 24 to 48 hours. Her father told the physician that they noticed the lesion on 25-AUG-2008, although it was reported that they said 'three days" in the nurse notes. The patient was normal, moving around not really complaining of anything other than the lesion being itchy. Her father said whenever they carry her across the chest she would cry and seem to be in pain. They had not given her medications. It looked like shingles to them so they brought her to the office for further evaluation and treatment. The patient has not been on prednisone. There had been no exposure to chickenpox or shingles either. Her pulse rate was 128, respiratory rate was 18 and temperature was 97.7. Examination of the lesion on the chest wall just at the level of about T6 over the xiphoid process of the sternum there are vesicular lesions, multiple in number of 11 to 15, around it was quite erythematous. There are also a few vesicular lesions just by the nipple level as well and when you look at he back a similar lesion was also on the same dermatome about T5 and 6 posteriorly but did not cross the midline. There really was not significant parenthesias on it, the patient did not complain of any pain over it either. No other lesions noted. The patient was diagnosed with herpes zoster, T4, 5 and 6 level, left side. At the time of the report, the patient was recovering from the event. Lesions still presented "on initial examination on 26-AUG-2008". The physician treated the patient with acyclovir 200 mg/5 ml's for 20 mg/kg, four times a day, about 4 teaspoons four times a day, told her to keep it covered, may wash it with soap and water, try not to be expose anyone who hasn't had chickenpox or shingles "because they will surely get this". 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 Oka/Merck vaccine VZV strain. The sample of the lesion was collected on 27-AUG-2008. The sample was taken from vesicular lesions on anterior left chest wall and posterior chest wall dermatome of T4 to T6. The PCR results for the specimen identified the presence of wild type VZV. Other vaccination history included: first dose of hepatitis B vaccine (manufacturer unknown) 06-AUG-2005; first, second and third doses of HIB conj vaccine (unspecified carrier) given on 04-Oct-2005, 13_Dec-2005 and 08-Feb-2006, respectively; first dose of influenza vaccine (manufacturer unspecified) on 16-NOV-2006; first, second and third doses of PEDIARIX given on 04-Oct-2005, 13-Dec-2005 and 08-Feb-2006, respectively; first, second and third doses of PREVNAR on 04-Oct-2005, 13-Dec-2005 and 08-Feb-2008, respectively. Additional information is not expected.