Age: 51.0
Sex: F
Vaccine: VARCEL
Symptoms: Muscle twitching, Nausea, Nervousness, Tremor
Clinical narrative: Information has been received from a consumer who is a 51 year old female pt, with an unknown history of immunity, anxiety, non-smoker, no allergy to eggs, and "Gyn Hx: menopause" who on 02/11/03 was vaccinated SC in the deltoid with a first dose of varicella virus vaccine live (Lot # 643083/0572M).  Other medications included estrogens, conjugated (+) medroxyprogesterone acetate (Prempro_ .625mg. On 02/11/03 at 10:10AM the pt complained of paresthesia which she described as a twitching sensation and mild crawling type sensation in her legs and feet and developed fatigue, weakness, trembling, felt hot, sweaty, nauseated, and had nervousness post vaccine for more than 1 week. After seeing a doctor, he believed "it was caused by something viral" and not the varicella vaccine live. Unspecified medical attention was sought.  Follow up visit with the family physician revealed that on 02/15/03 vital signs were BP: 122/85, Pulse: 92, Temp: 99.3; Pulse oximetry: 98. Physical exam was within normal limits. Tests performed were CBC and glucose.  Diagnosis was viral illness. RBC results were 4.15 M/uL. Treatment included: orthostatic BP's which were lying 146/88, p-77; sitting 152/70, p-79; standing 143/91, p-90; Decadron 4mg at 18:03 in the left "GM" and B12 1 cc IM at 18:03 in the left "GM": rest, increase fluids and acetaminophen/ibuprofen. It was also noted that the pt could return to work on 02/16/03 but could not take "repeat immunization for chickenpox due to adverse reaction to first immunization". RBC was 4.15 M/uL, glucose was 106 mg %.  Follow up visit with family physician on 02/19/03 revealed that the pt also developed tachycardia "shortly afterward" and felt "nervous" and "shakey" on 02/19/03. It was noted that the physician spoke with the CDC and they did not believe this was a side effect of the immunization, due to the longevity of the symptoms but the timing of the vaccine and the onset of the symptoms coincide with the reactions. Tests were CBC, LFT, MCP, Varicella titier, IgG, and IgM.  The assessment revealed that the weakness, sweating, nervousness, and techycardia "suggests S/E of immunization". AST was 41 IU/L and ALT was 73 IU/L.  All lab data are listed below. Treatment recommended not to receive second series of varicella vaccine and alprazolam 0.25 # 30.  Follow up visit with family physician on 03/11/03 revealed that the pt's legs twitch at night when trying to fall asleep. It was noted that "some symptoms are better - IE soreness in jaw, ear and neck". The pt was referred to an infectious disease physician to see if these symptoms were related to the vaccine. An initial visit with the infectious disease physician on 03/19/03 revealed that all of her symptoms seemed to have resolved, other than she is left with some mild crawling type sensation in her extremities" that in addition, was resolving. It was noted by the physician that it was not clear exactly what the array of symptoms were or even if it was from the vaccine, "although certainly the timing of it was suggestive". It was suggested that the pt get an EMG and nerve conduction of her extremities to be sure there was not a neurologic or muscular abnormality.  Additional information is expected.