Age: 50.0
Sex: F
Vaccine: VARZOS
Symptoms: Throat tightness, Urticaria
Clinical narrative: Neck stiffness; Sore neck; Allergic reaction; Abdominal cramps; Itchy swollen feet; Throat closing up; Face swelling; feet itching; Sore throat; Could barely swallow; Tongue swollen; Difficulty breathing through mouth; urticaria/ hives are ongoing and now have spread from her torso, arms, and legs to now her entire back is covered; Abdominal discomfort; Throat swelling; could not talk clearly; Lump in throat; This case was reported by a pharmacist via call center representative and described the occurrence of allergic reaction in a 50-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   Concurrent medical conditions included drug allergy (allergy to Benadryl).   On 16th July 2019, the patient received the 1st dose of Shingrix. On 18th July 2019, 2 days after receiving Shingrix, the patient experienced allergic reaction (serious criteria clinically significant/intervention required), abdominal cramp (serious criteria clinically significant/intervention required), swelling of feet (serious criteria clinically significant/intervention required), throat constriction (serious criteria clinically significant/intervention required), facial swelling (serious criteria clinically significant/intervention required), localized itching (serious criteria clinically significant/intervention required), sore throat (serious criteria clinically significant/intervention required), swallowing difficult (serious criteria clinically significant/intervention required), swollen tongue (serious criteria clinically significant/intervention required), difficulty breathing (serious criteria clinically significant/intervention required), urticaria (serious criteria clinically significant/intervention required), abdominal discomfort (serious criteria clinically significant/intervention required), throat swelling (serious criteria clinically significant/intervention required), speech disorder (serious criteria clinically significant/intervention required) and lump feeling in throat (serious criteria clinically significant/intervention required). On 22nd July 2019, the patient experienced stiff neck and neck pain. The patient was treated with chlorphenamine (Chlorpheniramine), steroids nos (Steroids), cetirizine hydrochloride (Zyrtec) and epinephrine. On an unknown date, the outcome of the allergic reaction, abdominal cramp, swelling of feet, facial swelling and abdominal discomfort were recovered/resolved and the outcome of the throat constriction, sore throat, swollen tongue, urticaria, throat swelling, speech disorder and lump feeling in throat were not recovered/not resolved and the outcome of the localized itching, swallowing difficult, difficulty breathing, stiff neck and neck pain were unknown.   It was unknown if the reporter considered the allergic reaction, abdominal cramp, swelling of feet, throat constriction, facial swelling, localized itching, sore throat, swallowing difficult, swollen tongue, difficulty breathing, urticaria, abdominal discomfort, throat swelling, speech disorder, lump feeling in throat, stiff neck and neck pain to be related to Shingrix.  Additional details were provided as follows: The patient received Shingrix on Tuesday and last night (before the day of reporting) developed abdominal cramps, abdominal pain and discomfort, allergic reaction with throat sore and closing up, feet itching around 12:15AM and she noted her feet and face were swelling around 4:30AM, at which point she went to take Chlorpheniramine. However, the back of her tongue and throat were swollen and she could barely swallow, she couldn't easily breathe through her mouth, and she couldn't talk clearly. She ended up going to the Emergency Room for treatment where she was given steroids and epinephrine.  After receiving treatment, symptoms rapidly resolved and she was released after 2.5 hours of observation. She was discharged with a 3 day course of steroids to take. The patient's throat was still not 100% normal feeling, but it's not swollen to point where she could not talk or breathe. It was reported that the patient's hives were ongoing and now have spread from her torso, arms, and legs to now her entire back was covered. The patient still felt as though there was a lump in her throat and still a little bit sore. On 22nd July 2019, the patient's neck became stiff and sore to the touch. She was seen by nurse on same day and received an unspecified long-acting steroid injection and was advised to take Zyrtec daily. The patient was not sure whether this was related to Shingrix, but adds she has not changed anything in her routine recently. The reporter consented to follow up.