Age: 74.0
Sex: F
Vaccine: VARZOS
Symptoms: Brain natriuretic peptide decreased, Bronchitis, Cardiac stress test normal, Cardiomegaly, Chest X-ray abnormal
Clinical narrative: Information has been received from a healthcare worker concerning a 75 year old female with an allergy to penicillin, osteoporosis, hypertension, hyperlipidaemia and osteoarthritis who on 19-JUL-2007 was vaccinated with Zostavax (Oka/Merck) (lot # 657767/0740U).  Concomitant therapy included ALTACE, alendronate sodium (MSD), CELEBREX, aspirin and CADUET. On 10-AUG-2007 the patient experienced herpes zoster and post herpetic neuralgia after receiving the Zostavax. As of 22-AUG-2007, the patient's herpes zoster and post herpetic neuralgia persisted.  Additional information has been requested. This is in follow-up to report(s) previously submitted on 9/24/2007. The patient was seen in the emergency room on 13-AUG-2007 for chest pain. The physician noted that she had a cough for the past two weeks, productive of some sputum without hemolysis. She denied a fever. On 09-AUG-2007 she had a few hours of left sided chest discomfort present only with deep breathing that went away and then it came back on 12-AUG-2007 in the afternoon and had been there since. It is there only when she took a deep breath and was localized on the left without radiation. There was no upper extremity, arm, neck, or jaw pain, no nausea, vomiting, dyspnea, lower extremity pain or swelling. There was no exertional component. When she breathes normally, she did not feel it at all- it is only there when she took a deep breath or when she coughed. The patient denied trauma. The pain was 5/10 in magnitude. The patient had a negative stress test in 2004. Physical exam- chest was clear to auscultation bilaterally, the chest pain can not be reproduced by palpation. The patient was in a regular rate and rhythm with no murmurs, rubs or gallops. The EKG was normal sinus rhythm, left axis deviation, normal intervals with nonspecific T wave flattening. Chest x-ray showed some right sided atelectasis, mild cardiomegaly, no acute disease. Labwork was performed which showed a D-dimer that was slightly positive at 429, so a spiral CT was performed which showed a hiatal hernia. Cardiac enzymes were normal x2 and the patient was discharged home. The impression was chest pain, and acute bronchitis. On 16-AUG-2007 the patient by her physician for a check-up. Physical exam- lungs clear, some left sided chest wall tenderness to palpation. Abdominal soft, non tender. Skin- raised or crusted herpetic lesions under bilateral breasts. EKG showed normal sinus rhythm with some non-specific ST wave changes in the anterior and inferior leads with some decreased voltage. The assessment was chest pain, most likely a post-herpetic neuralgia related to zoster secondary to ZOSTAVAX. The patient was started on FAMVIR. On 22-AUG-2007 the patient was seen by the physician for follow-up. The lesions were greatly improved though still crusting up. She had completed a weeks worth of famciclovir. The patient reported that her chest pain was improved, but she was still very fatigued. On exam there were multiple crusted lesions under both breasts, still some with heads and oozing at them on the far left side. The assessment was herpetic outbreak, chest pain due to herpetic neuralgia and hypertension. Information received on 20-SEP-2007 contained the following adverse event; hiatal hernia (13-AUG-2007). Additional information is not expected.