Age: 10.0
Sex: F
Vaccine: TTOX, VARCEL
Symptoms: Muscular weakness, Nuclear magnetic resonance imaging abnormal, Pregnancy test negative, Rash pustular, Red blood cell scan
Clinical narrative: Initial information has been received from a consumer concerning her 15 year old grand daughter with no medical history or allergies who on 25-MAR-2002 was vaccinated with a dose of VARIVAX (Oka/Merck).  Concomitant therapy included acyclovir and prednisone.  It was reported that the patient experienced Bells palsy on right side in July 2004, February 2005 and April 2007; and on left side in October 2006.  The patient had facial paralysis which for the most part went away after 5-6 weeks but had experienced "some lasting effects after receiving VARIVAX (Oka/Merck)".  It was noted that the date of onset for the patient's adverse events was also reported as 12-MAY-2003.  The patient was diagnosed with Melkersson Rosenthal syndrome.  Laboratory tests of magnetic resonance imaging and lumbar puncture were performed (results not provided).  Unspecified medical attention was sought.  A product quality complaint was not involved.  At the time of report, the patient had not recovered.  Additional information has been received from a registered nurse who confirmed that the patient did have multiple episodes of Bell's palsy and was subsequently diagnosed with Melkersson Rosenthal syndrome.  Follow up information was received from a health care professional concerning a 15 year old female with no prior medical history, pre existing allergies, or any noted adverse events following prior vaccinations.  The patient, who was exposed to her sister's chickenpox on 25 JAN 2002, but developed no symptoms, was vaccinated on 25 MAR 2002, subcutaneously into the left arm with a first dose of VARIVAX (Oka/Merck) (Lot # 639900/1151L).  On that same day the patient had stepped on a rusty nail, and was administered a first dose of tetanus toxoid (Aventis), intramuscularly into the right arm (Lot # U0381AA).  In MAY 2003, at age 12, the patient developed unilateral facial paralysis, involving the left side of the face, with recurrent episodes.  In OCT 2003 a recurrence occurred on the right side of the face, preceded by blister on the tongue several days prior.  Treatment at that time included acyclovir and prednisone, with a fairly good resolution, except for some problems with facial asymmetry.  In DEC 2003 the patient underwent an MRI of the brain, with nonspecific findings, not associated with her current symptoms.  In JAN 2004 the patient underwent a lumbar puncture.  Lyme titer in the spinal fluid was negative.  The patient was diagnosed at that time with Melkersson Rosenthal syndrome.  After a fourth episode of "tongue blisters" (date unspecified), the patient responded well to treatment with a high dose of acyclovir and prednisone.  She had a loss of taste in her tongue, but no actual facial paralysis.  On 5 APR 2007 the patient had a recurrence, with blisters on her tongue for two to three days, but did not take the medication because it caused abdominal pain.  Over the next two to three weeks the patient had progressive weakness of her eyebrow raising, nose flaring and smiles.  At that time the weakness had not worsened, but remained fairly significant.  The patient denied any recent illness or typical herpes stomatitis.  The patient admits to only small pustules on her tongue, none on her lips.  The grandmother reported the patient also experiences blurred vision in her right eye, which resolves after blinking several times.  The patient also had tinnitus, with no hearing loss, by hyperacusis.  On 3 MAY 2007 the patient underwent an MRI of the brain which showed inflammatory sinus disease of maxillary and ethmoid sinuses, with no acute intracranial process.  There was no evidence of nerve abnormality. On 4 MAY 2007 the patient underwent a CT of the chest.  Findings included a small pretracheal lymph node, and air within the gallbladder, found to be unusual in the absence of prior intervention or surgery, and was reported as uncertain significance.  An MRI of the face and chest, conducted on an undisclosed date, to rule out sarcoidosis was negative.  The patient underwent neurological and infectious disease evaluations regarding her four year history of recurrent Bells palsy, and was subsequently diagnosed with Ramsay Hunt syndrome.  The patient was currently on valacyclovir 1000 mg q 12hours for flare ups, to take for 14 days.  Additional information has been requested.