Sex: F
Vaccine: FLU4, COVID19, FLUX
Symptoms: Cough, Dyspnoea, Productive cough, Pyrexia
Clinical narrative: Still coughing and some green stuff; 99.8 degree fever; Worsening shortness of breath; Increased coughing; Increased sputum; This case was reported by a consumer via other manufacturer and described the occurrence of fever in a 67-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   Co-suspect products included Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2021-2022 season) for prophylaxis, COVID-19 VACCINE (COVID-19 VACCINE UNKNOWN) for prophylaxis and dupilumab (Dupixent) solution for injection in pre-filled pen for illness.   Concurrent medical conditions included drug allergy (Metoprolol Succinate and Lisinopril 10 mg tablet) and penicillin allergy (Penicillin VK 250 mg tablet). Concomitant products included acetylcysteine, guaifenesin (Mucinex), fluticasone furoate + umeclidinium bromide + vilanterol trifenatate (Trelegy), paracetamol (Tylenol), salbutamol sulfate (Albuterol Sulfate), ipratropium, salbutamol (Albuterol), simeticone (Gas-X), potassium chloride, doxepin, dexlansoprazole (Dexilant), bumetanide, fexofenadine hydrochloride (Allegra Allergy), amlodipine besilate (Norvasc), atorvastatin calcium and zafirlukast (Accolate).   On an unknown date, the patient received Shingrix. On 20th October 2021, the patient received Influenza vaccine Quadrivalent 2021-2022 season. On an unknown date, the patient received COVID-19 VACCINE UNKNOWN. On 22nd September 2021, the patient started Dupixent (subcutaneous) 150 mg/ml 300 mg at an unknown frequency. On 3rd November 2021, the dose was changed to 300 mg at an unknown frequency. In October 2021, less than 2 months after receiving Shingrix and less than 2 weeks after receiving Influenza vaccine Quadrivalent 2021-2022 season, the patient experienced increased shortness of breath, cough aggravated and sputum increased. On 21st October 2021, the patient experienced fever. On an unknown date, the patient experienced sputum discolored. The patient was treated with azithromycin, doxycycline, steroids nos (Steroids), prednisone, ipratropium bromide + salbutamol sulfate (Duoneb), sodium chloride (Hypertonic Saline) and ipratropium bromide. The action taken with Dupixent was unknown. On 22nd October 2021, the outcome of the fever was recovered/resolved. On an unknown date, the outcome of the increased shortness of breath was recovering/resolving and the outcome of the cough aggravated and sputum increased were not recovered/not resolved and the outcome of the sputum discolored was unknown.   It was unknown if the reporter considered the fever, increased shortness of breath, cough aggravated, sputum increased and sputum discolored to be related to Shingrix and Influenza vaccine Quadrivalent 2021-2022 season.  Additional details were reported as follows: The patient self-reported this case. The age at vaccination was not reported. The patient started loading dose of Dupixent 22th September 2021 then received the Covid booster, Flu vaccine (Flu vaccine VII), and Shingles shot (Shingrix) and was instructed by her md (physician) to take 2 to 3 weeks off of the dupixent at that time, and that why she had a gap in therapy.  In November 2021 Dupixent (Dupilumab) 300 mg, every other week (QOW). 1 day after Influenza vaccine Quadrivalent 2021-2022 season, 29 days after receiving Dupixent and less than a month after Shingrix and Covid-19 vaccine, the patient had 99.8-degree fever and then fever went away. Less than 2 months after vaccination with Shingrix and Covid-19 vaccine and following the first dose of Dupixent, the patient had worsening shortness of breath and increased sputum and coughing.  The patient was put on azithromycin course along with a 4-day steroid course, she got worse and was put on doxycycline and another steroid course, this time prednisone 40 mg x 4 days, 30 mg x 4 days, 20 mg x 4 days, then 10 mg x 4 days.  The patient was currently feeling 75 to 80 percent better and was not as short of breath as was 2 weeks ago.  The patient had been still doing duo neb twice daily and was using hypertonic saline as well.  The patient finished doxycycline and prednisone course weekend from the day of reporting. Less than 1 month after Influenza vaccine Quadrivalent 2021-2022 season, less than 2 months after vaccination with Shingrix and Covid-19 vaccine and following the first dose of Dupixent, the patient was still coughing and some green stuff. In context of covid-19 crisis, information on batch number was not requested. It was unknown if the reporter considered the fever, increased shortness of breath, cough aggravated, sputum increased, and sputum discolored to be related Covid-19 vaccine and Dupixent.