Age: 67.0
Sex: F
Vaccine: VARZOS
Symptoms: Blood pressure, Dermatitis contact, Immunisation reaction, Paraesthesia, Pruritus
Clinical narrative: Information has been received from a medical assistant concerning a 68 year old female with hypothyroidism, osteopenia, hiatus hernia, fibromyalgia, Sjogren's syndrome and allergies to sulfamethoxazole (+) trimethoprim (Bactrim), ciprofloxacin (Cipro), cephalexin (Keflex), aspirin (+) oxycodone hydrochloride (+) oxycodone terephthalate (Percodan), tetracycline, and azithromycin (Zithromax) and tetracycline who on 21-Aug-2007 was vaccinated with zoster vaccine live (Oka/Merck) IM in the L arm (lot no. 658086/0761U).  Concomitant therapy included levothyroxine Na (Synthroid), salcatonin (Miacalcin), pantoprazole sodium (Protonix), tramadol HC1 (Ultram) and cholestyramine resin.  In 2007 the patient developed a red pimple-like rash with a discharge, that was itching and tingling around the rash on her chest, back, both arm and back of head.  On 13-Sep-2007 the patient was examined in the physician's office and she was prescribed hydroxyzine hydrochloride (Atarax) and methylprednisolone (Medrol) dose pack.  The patient was examined by a dermatologist but the results of the exam were unknown.  On 30-Sep-2007 the patient was seen in a local emergency room and the methylprednisolone pack was continued.  On 01-Oct-2007, the patient was examined in the physician's office and the rash was resolving.  The patient was advised to continue the methylprednisolone and she was also prescribed loratadine (Claritin) and diphenhydramine (Benadryl).  Follow up information was received from the physician concerning a 67 year old female, who presented to the doctor's office with complaint of a generalized rash.  Upon examination the patient was found to be well developed, well nourished, and in no acute distress, with papules on the anterior trunk, macular papular area of the left antecubital.  The patient stated that "the rash started eight days after receiving zoster vaccine live (Oka/Merck) vaccination".  The patient denied any other known trigger.  The patient was initially seen in the office (undisclosed date) with a rash of her left antecubital area and was diagnosed with contact dermatitis and prescribed medrol dose pack.  The patient stated that "two days after finishing the steroids the rash came back and flared up".  The patient was seen by a neighbor who is a dermatologist and was given a cortisone injection and other Prednisone Taper over a longer period.  Two days after completing the therapy the patient had a generalized red urticarial macular papular rash on her trunk and extremities.  The patient had gone to the emergency department for evaluation.  At the time of examination the patient was currently on day three of a 10 day steroid taper.  The rash had improved and the patient had several scattered papules on the trunk and left antecubital area.  An immunization reaction was suspected by the examining physician, and loratadine 10 mg a.m., diphenhydramine hydrochloride (Benadryl) 150 Mg HS was recommended.  The patient was instructed to follow up if further problems or no improvement.  Additional information is not expected.