Age: 54.0
Sex: F
Vaccine: FLUX, VARZOS, FLUX, VARZOS, FLUX, VARZOS
Symptoms: Antineutrophil cytoplasmic antibody, Arthralgia, C-reactive protein normal, Discomfort, Dyspnoea
Clinical narrative: This medically confirmed report (initial receipt 19-Mar-2014) concerns a 54 year old female patient who had a medical history of right trigeminal neuralgia, PUD (Peptic Ulcer Disease), osteoporosis and a lesion on the tongue (that come and go and were mildly irritated). The patient denied tobacco use, ethanol use and recreational drugs. The patient had no family history of autoimmune disease, no travel history and no sick contacts. On the 08-Nov-2013, the patient received Influenza vaccine (manufacturer and batch number not reported) and ZOSTAVAX (batch number J00434) in the left arm via the subcutaneous route. On the 09-Nov-2013 at 08:00, the patient developed a crawling sensation under the skin which felt like spiders were crawling all over her. Ever since the shingles vaccine, she had not felt well. The patient experienced fatigue, numbness and tingling in the hands and feet (which she had not had before), dyspnoea, heart palpitations, arthralgia, numbness of the right face and head pressure. The patient had no motor weakness and no other neurological symptoms. The patient had no abnormalities on physical examination. The patient was prescribed with a weaning dose of prednisolone for six days, commencing on the 15-Nov-2013. On the 23-Nov-2013, the patient returned to the medical clinic and reported fairly diffuse arthralgia involving the major joints of the upper and lower body and has also felt some arthralgia occurring within her spine. Her skin felt as if it was crawling and was itchy. The patient denied any rash and fever. The patient had normal appetite and did not have abdominal discomfort or problems with her urinary system. The prednisolone did not assist the patient. Lab work which was completed on the 18-Nov-2013 was unremarkable, other than a mildly low white cell count at 3600 with stable counts. Her complete metabolic panel was normal and a C - reactive protein and sedimentation rates were both normal as were the results of a physical examination. The patient was prescribed nabumetone (750 mg, bid) for few weeks to help with discomfort and cetirizine (10 mg, daily) for the itch. The patient was diagnosed with a systemic reaction to the combination of the influenza and varicella virus vaccine. On the 05-Dec-2013, the patient returned to the medical centre and reported that she did not take the prescribed NSAIDS (non-steroidal anti-inflammatory drugs) or the antihistamines. The joint aches and pain in the elbow, knee, wrist occurred for a few minutes up to ten times a day. The crawling feeling under the skin was constantly present. The symptoms of paraesthesia and joint aches did not awaken the patient at night. On physical examination, all examinations were normal. Additional treatments included gabapentin which was commenced on the 07-Jan-2014 and acyclovir which was commenced on the 12-Mar-2014. Relevant diagnostic tests include CBC (complete blood count), ESR (erythrocyte sedimentation rate), and CRP (C - reactive protein) which were all normal. RF (rheumatoid factor), SPEP (serum protein electrophoresis), ANCA (anti-neutrophil cytoplasmic antibody) and varicella IgM were also examined. Outcome was reported as improving (recovering). Reporter comments: The reporter did not see any concerning findings such as Guillain Barre Syndrome or allergic reaction. The symptoms were associated with a robust immune response to the vaccine. The reporter stated that arthralgia and paraesthesia were likely a temporary reaction to the shingles vaccine.