Age: 73.0
Sex: F
Vaccine: VARZOS
Symptoms: Abdominal pain lower, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood cholesterol increased
Clinical narrative: Information has been received from a consumer concerning his wife a 74 year old female with back trouble who on 04-AUG-2008 was vaccinated with the first dose of ZOSTAVAX (Oka/Merck).  Concomitant therapy included ALEVE and vitamins (unspecified) and unspecified supplements.  It was reported that about a day later, (on 05-AUG-2008) the patient experienced a "violent diarrhea".  Per caller, the patient had diarrhea attacks in the morning 2 to 3 times and again about the same number of diarrhea attacks in the afternoon to the point that she was actually inserting tampons because it was just uncontrollable.  The patient sought medical attention.  At the time of the report, the patient's "violent diarrhea" persisted.  This is one of two reports received from the same source.  Follow-up information has been received from a physician which reported that the patient with (IBS) for evaluation of diarrhea on 29-AUG-2008, was 73 year old.  She had alternating constipation and diarrhea for all of her life.  It was reported that the patient had a colonoscopy several years but could not report exactly when.  It was reported that for the last 3 weeks, on approximately 08-AUG-2008 (previously reported as 05-AUG-2008), she had had persistent diarrhea.  She was typically having 6-7 watery diarrhea.  The patient has a history of hemorrhoids and had a small amount of red blood on 28-AUG-2008.  It was reported that the patient admitted to weight gain.  It was also reported that the patient had one episode of nocturnal diarrhea.  There were no fever or chills.  It was reported that the patient had lower abdominal pain, which was constant.  She had had abdominal pain that was similar in the past.  The patient tried BENTYL, IMODIUM, LOMOTIL, kaopectate without much relief.  The patient was taking antibiotics (possibly sulfa) 1 week ago.  The patient was given a prevention shot for shingles.  It was reported that diarrhea which was persistent for the last 3 weeks rule out IBS flare, infectious diarrhea, inflammatory bowel disease.  The patient has not responded to IMODIUM and LOMOTIL.  It was reported that cholestyramine will be tried for the patient.  The reporter physician felt that it was unlikely that the patient's shot for shingles would have caused this.  The patient was encouraged to stay well hydrated to prevent dehydration.  On 09-SEP-2008, the patient started bladder infection symptoms, it was reported that she had had this multiple times.  The patient was able to take BACTRIM twice which she had left over from travel as well as PYRIDIUM and feeling better.  No fever or back pain were reported.  It was also reported that the patient had quite a bit of vomiting and nausea.  It was reported that the patient had no costovertebral angle tenderness, belly soft, completely nontender, no hepatosplenomegaly noted and urinalysis unreadable because of PYRIDIUM.  On 10-SEP-2008 blood work was performed, sugars were up a bit, fasting 109 mg/dL, haemoglobin glycosilate 6.1.  It was pointed out that liver enzymes were elevated, serum aspartate aminotransferase test 85, serum alanine aminotransferase test 111.  It was reported that the patient never had liver enzymes elevation previously to her knowledge.  Laboratory test performed in May 2008 showed normal liver enzymes.  It was also reported that on 10-SEP-2008 the patient's diarrhea had settled down significantly.  The patient took lots of IMODIUM and lots of BENTYL.  The patient was told to avoid alcohol or TYLENOL, other substances which could cause further liver problems.  The patient had no jaundice.  On 12-SEP-2008, the patient was told to take phenazopyridine 200 mg, 1 tablet once a day prn.  The physician considered severe diarrhea to be an other important medical event.  No further information is available.