Age: 71.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site pain, Injection site pruritus, Injection site urticaria, Urticaria
Clinical narrative: E-coli Urinary tract infection; whelps at site; pain at site; itching at site; redness at site; Discomfort; This case was reported by a physician via call center representative and described the occurrence of escherichia urinary tract infection in a 71-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   Co-suspect products included mepolizumab (Nucala) powder for injection for eosinophilic granulomatosis with polyangiitis.   The patient's past medical history included walking difficulty (had difficulty walking up stairs) and difficulty breathing (had breathing dificullty). Concomitant products included sertraline hydrochloride (Zoloft), omeprazole, atorvastatin, hydrochlorothiazide, amlodipine, gabapentin (Gabapentine), budesonide + formoterol fumarate (Symbicort), beclometasone dipropionate (Qvar), prednisone and mycophenolic acid (Mycophenolate).   In October 2020, the patient received the 1st dose of Shingrix. In November 2020, the patient started Nucala (subcutaneous) 300 mg cyclically. On an unknown date, the dose was changed to 300 mg cyclically. On 12th January 2021, the dose was changed to 300 mg cyclically. In November 2020, less than 2 months after receiving Shingrix, less than a week after starting Nucala and an unknown time after starting Macrobid, the patient experienced escherichia urinary tract infection (serious criteria GSK medically significant), injection site urticaria, injection site pain, injection site itching, injection site erythema and discomfort. The patient was treated with macrobid (nos) (Macrobid), ciprofloxacin (Cipro), benadryl (nos) (Benadryl) and celecoxib (Celebrex). The action taken with Nucala was unknown. On an unknown date, the outcome of the escherichia urinary tract infection, injection site urticaria, injection site pain, injection site itching, injection site erythema and discomfort were recovered/resolved.   It was unknown if the reporter considered the escherichia urinary tract infection, injection site urticaria, injection site pain, injection site itching, injection site erythema and discomfort to be related to Shingrix and Nucala.  Additional details were provifded as follows: The reporter was the patient's husband. The patient had difficulty walking up stairs and give out breath as a historical condition. The patient received 1st dose of Nucala(batch number EGPA)  in November 2020 and 1st doe of Shingrix in October 2020. The patient received all three in the office and the 300mg has been in 3 seperate shots all in lower abdomen. The reporter stated that, 12 to 24 hours after the first injection she had an E-coli urinary tract infection. The patient received Macrobidbut the urinary tract infection returned, which led to drug ineffective. Less than 2 months after vaccination with Shingrix, the patient experienced escherichia urinary tract infection, injection site urticaria, injection site pain, injection site itching and injection site erythema. The day before reporting, the patient had eosinophils level as down to 1 percent.  The patient received Cipro, Benadryl 25 mg, Celebrex 200mg as a treatment medication. The reporter stated that prior to 2nd and 3rd dose of Nucala, the patient received pre medication and had no issue with 2nd dose but had redness, itching and discomfort again but not as significant as the first time. The reporter stated that, prior to Nucala, but on a lot of other medications and inhalers, the patient's  eosinophil level was 9 to 12, at the end of December. The reporter stated that, aafter starting Nucala the patient could walk up stairs without shortness of breath and breathing had improved by 80 percent. The patient received 2nd dose of Shingrix in December 2020. The reporter consented to follow up.