Age: 69.0
Sex: M
Vaccine: VARZOS
Symptoms: Skin lesion, Varicella virus test positive
Clinical narrative: Information has been received from a 71 year old male patient with a history of rotator cuff repair on each shoulder, one in 2006 and one in 2009 because of rotator cuff tears who in November 2008, was vaccinated subcutaneously with a 0.65 ml dose if ZOSTAVAX (Merck). Concomitant therapy included codeine. Patient reported that on 07-JUL-2010, he noted a pimple on his back just above his kidneys. On 08-JUL-2010, the patient noticed a small red rash below his rib two inches to the rear, and the following day there was another above the navel and had a partial lump. On 09-JUL-2010, patient went to his dermatologist who diagnosed his symptoms as shingles. Patient was prescribed VALTREX (manufactured unspecified). On 11-JUL-2010, patient went to hospital and saw the doctor who confirmed Herpes zoster and prescribed prednisone (manufacturer unspecified). On the night of 11-JUL-2010, patient applied LANACANE, an over the counter cream (manufacturer not specified) with sand paper and he felt like he was being "cut by a razor blade". Patient mentioned that the cream had relieved the itching from his shingles blisters. Patient also reported that he was experiencing ingrown hair, severe pain, rash, and pustules. Patient also stated that he had not slept in four days because of the pain. Also, he was not able to touch the rash because it felt like "he was being hit with a bat in his rib cage". At the time of the report the patient was not recovered. Lab diagnostics studies were not performed. Patient sought medical attention by a visit to the hospital. Follow up information has been received from a physician concerning a 71 year old male patient with no known drug allergies, hyperlipidaemia, hypertension, diabetes mellitus and coronary artery disease and a history of rotator cuff repair and chickenpox as a child (age 5) who on 12-NOV-2008, was vaccinated with a dose of ZOSTAVAX (Merck) (lot number: 659672/0294X) in the left arm. Concomitant therapy included codeine, simvastatin, verapamil HCl, metformin hydrochloride (+) sitagliptin phosphate, aspirin, vitamins (unspecified), TRILIPIX, ALTACE and ACTOS. Subsequently, on 07-JUL-2010, the patient experienced herpes zoster at T8-T9 right dermatome (duration 1 week). The patient had a maculopapular rash with scabbing and crusting. There was no recent exposure to chickenpox or shingles. The patient had a 97.5 body temperature and no other systemic symptoms reported. The patient rated the pain as 7 on a scale of zero (least) to ten (most) scale. A lesion sample was collected on 14-JUL-2010. The sample was taken from a healing lesions/scab. There was no photo taken. At the time of the report, the patient was recovering. It was noted that the lesions we re healing. It was also noted that the rash was still present and that the pain had slightly improved. The patient was enrolled in the Varicella Zoster Virus Identification Program to identify if VZV is present and if it is present, to identify if it is associated with the wild type (WT) VZV strain or with the Merck vaccine strain. Follow up information has been received from the physician who reported that the PCR result from the scab specimen identified the presence of Wild Type VZV. B-globin DNA was not amplified. No additional information is expected.