Age: 64.0
Sex: F
Vaccine: VARZOS
Symptoms: Malaise, Mental impairment, Musculoskeletal pain, Musculoskeletal stiffness, Myalgia
Clinical narrative: Information has been received from a nurse practitioner (also reported as registered nurse) concerning a 64 year old female patient who on 04-AUG-2010, was vaccinated with a dose of ZOSTAVAX (Merck). A few weeks later, the patient developed shingles which was discovered on 15-AUG-2010 when the patient returned to the doctor's office. The patient's shingles persisted. Follow up information has been received from the registered nurse concerning the 64 year old female patient with MACRODANTIN and sulfanilamide allergy and having a chickenpox when being a child who on 04-AUG-2010 at 09:30 was vaccinated SC with the first dose of ZOSTAVAX (Merck) (lot number 665530/0697Z) in left upper arm. On 04-AUG-2010 after vaccination, the patient noticed that her neck felt stiff and her muscles were sore and she was kind of achy. She also felt like she had a low-grade fever. This continued and on Friday about 3 days ago, on approximately 13-AUG-2010, she had a fever of about 100 as well as some chills and sweats. Then yesterday on approximately 15-AUG-2010 she noticed a rash on her left lower breast that extended into her back. She stated there was pain in the area probably for several days prior, but she just noticed the rash yesterday. She stated it was quite painful. The pain was nine to ten in the quantify measurement of which the least was zero and the most was ten. The specimen was not collected for PCR. There was no photo taken. She denied any itching. She had been taking ibuprofen for the pain. She stated it radiated into her back and shoulder blade. The chills, sweats and achiness had pretty much resolved. Also of note was she had urinary tract infection that was confirmed by urinalysis on 04-AUG-2010. She was treated with CIPRO and stated that cleared up. The patient was in another state and extended air travel one to two weeks prior and was unknown to exposure to chickenpox or Herpes Zoster. The patient was almost recovered but post herpetic pain persisted. The patient was treated with acyclovir 800 mg orally 5 times per day for 7 days. NEURONTIN 300 mg orally daily for one day, BID for 2 days then TID, might increase up to 2 orally TID. The patient was advised to alternate ibuprofen with TYLENOL in needed for her pain. On 06-AUG-2010 the patient noted that she had increasing achiness of her head, neck, HA in general, some periscapular discomfort, and just not feeling very well. On 13-AUG-2010 she started having some fever and chills. The patient did not feel very well with her stomach. On 15-AUG-2010 she broke out in a rash, which was vesiculopapular. It was around her left breast and posteriorly in the periscapular region. She felt mentally slow and just not feeling very well at all. She indicated that since 06-AUG-2010 her pain distribution had been in the same area as this rash. She now experienced continued discomfort. On 19-AUG-2010 evaluation, it revealed that she indeed had vesiculopustular rash on erythematous base in above stated distribution. The physician considered there were many other events besides the vaccination precipitated the patient's shingles such as increased stress, not feeling well, urinary tract infection, returning from vacation and on the plane for extended time that could be possibility for her expose to someone else that had herpes zoster or chickenpox. On 31-AUG-2010 the patient came to see physician and reported that she had such discomfort that she was unable to sleep at night and was very frustrated and "sick of vits and sick of meds". The patient was in no acute distress. The skin was remarkable for her area across her breast and going to the midline in the back with some scaling and some violaceous skin markings and changed consistent with recent herpes zoster. She didn't have a lot of scabbing left at this time, only some scaling. The patient was diagnosed with follow up Herpes Zoster, anxiety/depression and post herpetic neuralgia. The patient was treated with ibuprofen 800 mg 3 times daily, capsaicin cream, gabapentin and nortriptyline 10 mg once. The patient was advised by the physician to keep her vitamins including fish oil, vitamin C, CENTRUM and eye vitamin and to capture any other supplements. Additional information has been received from the nurse practitioner indicated that she only had a record of this patient receiving ZOSTAVAX (Merck) and Tdap (manufacturer unknown). Follow up information has been received from the nurse practitioner indicated the patient was doing better. Additional information is not expected.