Age: 60.0
Sex: F
Vaccine: VARZOS
Symptoms: Computerised tomogram head, Ear, nose and throat examination, Facial pain, Headache, Hypoacusis
Clinical narrative: Information has been received from a consumer concerning his 60 year old wife who on 12-DEC-2006 was vaccinated with a dose of Zostavax. On 30-DEC-2006 the patient was diagnosed with symptoms of a "typical nerve disorder". Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/14/2007; 6/22/2007; 7/5/2007.  Information has been received from a reporter concerning his 60 year old caucasion wife with no drug allergies, migraine (on the right side for 40 years), hypertension, osteopenis, cataracts, and interstitial cystitis who on 12-DEC-2006 at approximately 09:00 was vaccinated SC in the left deltoid with a first dose of varicella-zoster virus vaccine live (Oka/Merck).  There was no illness at the time of vaccination.  Concomitant therapy included losartan potassium (MSD), TOPROL XL TABLETS, desipramine HC1, alendronate sodium (MSD), rizatriptan benzoate (MSD), niacin, FIORICHT TABLETS and "Elmira."  On 30-DEC-2006, the patient was diagnosed with symptoms of a "typical nerve disorder."  Unspecified medical attention was sought.  There was no product quality complaint involved.  Additional information has been received from the patient's neurologist, including medical records.  The neurologist noted that he was consulted only and did not get the vaccine.  The patient was seen on 06-FEB-2007 by the neurologist for the chief complaint of left facial pain.  The symptoms began on 28-DEC-2006.  She started to notice pain around the left temple and periorbital region on the left.  The pain could become very intense and have a duration of several hours.  It was a constant pain most of the time with occasional sharp pains.  There was no associated change in vision or speech.  There was no swelling of the eye or redness and no change in the nasal drainage or congestion.  She did get associated roaring tinnitus, mostly in the left ear, in association with the acute pain episodes.  Her hearing was diminished during these episodes only.  There may also have been some left posterior neck pain.  The neck pain had been a recurrent issue for many years.  She found that coughing or sneezing would exacerbate symptoms.  She usually felt better when she was supine.  She was treated with several courses of antibiotics without any improvement.  After an ENT evaluation, it was felt that the problems were not related to the sinuses and most likely were neurologic, prompting the consult.  She had CT scans of the sinuses and brain with no significant abnormalities.  The impression was atypical facial pain most likely representing a variation of trigeminal cephalgia.  The distribution was predominantly V1.  The precise precipitating factor was not clear.  Her examination was unremarkable and negative imaging with CT scan ws reassuring for no masses or other serious intracranial pathology.  The plan included a trial of LYRICA and indomethacin and to be followed-up in one month.  A follow-up visit was done on 23-FEB-2007.  She presented with atypical facial pain and unusual form of tinnitus.  Since taking the LYRICA, the pain was 90 percent controlled.  However, she stated that the roaring sound in the ear persisted and was very bothersome.  She was an ENT who had no specific explaination for the symptoms.  He recommended a low salt diet and a diuretic.  She was already using MAXIDE.  Her hearing is normal.  The impression was that her pain was much improved with LYRICA but persistence of roaring sensation in the head.  The mechanism remained elusive as did the cause.  The plan included trying cyclobenzaprine hydrochloride (MSD) 10 mgs as needed.  She would continue the LYRICA 75 mg BID.  The neurologist talked about looking at the cerebral vasculature with an angiogram.  He was skeptical whether he would find anything treatable or even related to this.  However, they might ultimately do this for completeness since a vascular malformation near the cochlea might produce a phenomenon like this.  She would follow-up in one month.  She was seen for a follow-up visit on 19-APR-2007.  Her tinnitus had almost fully resolved.  Her facial pain was well controlled.  There were still intermittent pains, particularly with any form of valsalva such as coughing, laughing or sneezing.  The impression was stable atypical facial pain but concerns about valsalva maneuvers including symptoms.  The possibility of aneurysm or vascular anomaly was discussed.  The plan included recommending a CT angiogram of the head but he would not expect it to show any abnormality.  The patient would decide if she wanted to proceed with the test.  The patient's experience was considered to be disabling by the neurologist.  No further information is expected.  This is an amended report.  The reporter was changed from a consumer to the neurologist.  Follow up information was received from a physician who reported that the patient developed pain around the left eye and roaring in the ear, especially with valsalva, that was diagnosed as temporal mandibula myofascial syndrome. The patient had a CT of the brain and sinuses and visist with an ENT and a neurologist. The physician noted that the patient got ZOSTAVAX on 12-DEC-2006 and the adverse events started later in December 2006. The patient's experience was considered to be disabling by the neurologist. No further information is expected.