Age: 65.0
Sex: F
Vaccine: FLUX, PPV, TTOX, VARZOS
Symptoms: Influenza like illness
Clinical narrative: This case was reported by a pharmacist and described a 63-year-old female subject who developed severe flu symptoms after receiving an influenza vaccination (other manufacturer) . There were no concomitant medications or pertinent medical history.  The subject's concurrent medical conditions were not reported.  The subject had a sulfa allergy. On an unspecified date several years ago, the subject received influenza vaccine (unknown manufacturer: dose number and lot number not provided).  On an unspecified date, the subject developed severe flu symptoms after receiving the influenza vaccination.  No other symptoms were reported. No other information was available. This is in follow-up to report (s) previously submitted on 10/16/2006. Information has been received from a physician and a 65-year-old female who is a physician with asthma, allergies (ragweed) and penicillin an aspirin allergies, who on 22-SEP-2006 at 10:30 am was vaccinated subcutaneously in the right arm with a first dose 0.65 ml dose of ZOSTAVAX vaccine (Merck). Concomitant vaccination included: a dose of pneumococcal 23v ploysaccharide vaccine (MSD), a dose of inlfuenza virus vaccine (unspecified) (given on the same arm about 3 inches away from the site of varicella-zoster virus vaccine live (Merck) administration) and a dose of tetanus toxoid vaccine (manufacturer unknown). Other concomitant medications included: ADVAIR, SINGULAIR and ALLEGRA. On 23-SEP-2006 the patient expereinced a severe localized reaction on her right arm including erythema, pain/tenderness, swelling, pruritus and warmth. The patient did not experience any systemic reations, no fever, no sore throat and no joint pain. It was reported that the reaction gradually subsided after 6 days and significantly reduced after 10 days. On 05-OCT-2006, the patient  was seen by the allergist, she still had a mild macular eythema, but no other skin lesions were identified. The patient was also wondering whether she should receive her additional allergy immunotherapy which she is getting about once every 4 weeks. She was also treated in the allergist office for asthma, aspirin and penicillin allergy. The physician discussed the potential etiologies for her raction to varicella-zoste virus vaccine live (Merck). The time sequence may resemble either type-3 or type-4 hypersensitivity. In addition, patch testing for varicella-zoster virus vaccine live (Merck) may also be beneficial which potentially can help us to identify whether she has any T-cell mediated hypersensitivity reaction. There is always a possibility the reaction could be directed to the preservatives. Ingredients of the vaccination have to be examined to see whether additional patch testing can be performed. The physician recommended that she get IgG and IgM antibody titers for VEV. The results of these tests were varicella-zoster Ab, IgM = < 0.90 (negative) and varicellla-zoster V Ab, IgG = 4.24 (positive). The physician noted that the patient could continue her current prescribed allergy and asthma medication and continue to receive her immunothereapy as planned. No product quality complaint was involved. No additional information has been requested.