Age: 68.0
Sex: F
Vaccine: VARZOS
Symptoms: Biopsy, Blister, Burning sensation, Pain, Psoriasis
Clinical narrative: Information has been received from a physician concerning a 68 year old morbidly obese female with drug allergies to lisinopril (WAES#0806USA00584) and verapamil, extensive psoriasis, psoriatic arthritis and weekly photo-therapy who "about three weeks ago," on approximately 30-APR-2008, was vaccinated with zoster vaccine live (Oka/Merck) while on therapy with ENBREL (it was uncertain if the patient had received etanercept therapy that same day). "About one week after receiving zoster vaccine live" (also reported as about 4 days after vaccination), on approximately 14-MAY-2008, the patient experienced burning and stinging and then noticed little painful spots. The patient was seen by her internist who thought it was related to her psoriasis so he referred her to her dermatologist. On exam she had small patches of psoriasis and he found one clear vesicle in an area where no psoriasis was present. He was quite sure it was chickenpox blister, but performed a biopsy to confirm whether it was a viral vesicle or a pustular psoriasis flare-up. He mentioned he thought this was a mild case of vaccine varicella. As of 21-MAY-2008, the patient had not recovered from the chickenpox. The product quality complaint unit was not involved. Additional information has been requested. Follow-up information was received from the physician which indicated a patient with psoriasis (started in 1962), type 2 diabetes mellitus, hypertension, chronic headache, chronic depression was vaccinated on 21-APR-2008 with a dose of ZOSTAVAX (Merck). Concomitant therapy included ENBREL, acyclovir, ZYRTEC, butalbital, CARAFATE, cimetidine, LIPITOR, piroxicam, lisinopril, omeprazole, PRILOSEC, DEMORAL HYDROCHLORIDE, NIZORAL, triamcinolone, clobetasol propionate, CLOBEX and atenolol. Three weeks after vaccination (also reported as 25-APR-2008) the patient developed a rash that was originally thought to be a psoriasis flare up. When she was seen by a dermatologist they noted that the rash was vesicular with many lesions and general distribution. The patient complained bitterly of stinging burning and other unusual sensation superimposed on her usual psoriasis around her waistline. She was suing AVEENO lotion. At least one of the lesions she pointed to was a definite vesicle--totally different from her all psoriasis patches and plaques. There were a number of healing crusted lesions which the patient said were similar. A specimen was taken via a punch biopsy to determine VZV PCK. The results showed VZV DNA negative. Additional information has been requested.  This is in follow-up to report (s) previously submitted on 6/24/2008; 09/24/2008.  Follow-up information was received from the physician which indicated a patient with psoriasis (started in 1962), type 2 diabetes mellitus, hypertension, chronic headache, chronic depression was vaccinated on 21-APR-2008 with a dose of ZOSTAVAX (Merck).  Concomitant therapy included ENBREL, acyclovir, ZYRTEC, butalbital, CARAPATE, cimetidine, LIPITOR, piroxicam, lisinopril, omeprazole, PRILOSEC, DEMEROL HYDROCHLORIDE, NIZORAL, triamcinolone, clobetasol propionate, CLOBEX and stenolol.  Three weeks after vaccination (also reported as 25-APR-2008) the patient developed a rash that was originally thought to be a psoriasia flare up.  When she was seen by a dermatologist they noted that the rash was vesicular with many lesions and general distribution.  The patient complained bitterly of stinging burning and other unusual sensation superimposed on her usual psoriasis around her waistline.  She was using AVEENO lotion.  At least one of the lesions she pointed to was a definite vesicle-totally different from her all psoriasis patches and plaques.  There were a number of healing crusted lesions which the patient said were similar.  The lab results showed VZV DNA negative.  Additional information has been requested.