Age: 63.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site pain, Injection site swelling, Malaise, Musculoskeletal stiffness, Vertigo
Clinical narrative: Patient received a Zostavax vaccine from me on 4/7/15 under the immunization protocol for physician.  She called the pharmacy on 4/9/15 at approximately 2:00-2:15pm complaining of a site reaction and an acute illness that began this morning.  She informed me that she had on the back side of her left arm at the injection site a silver-dollar sized, red, firm and irregularly shaped area that was painful which she had noticed this morning.  She also said that she had felt fine until this morning when she began to have vertigo, stiffness at the back of her neck, stomach upset and vomited all brown liquid one time.  She said her stomach was still a little upset and that she had 4 large, loose bowel movements already today. She said that she was still feeling light-headed and had taken her temperature today and that it was 98.1F. She said she had taken some of her usual medications this morning including her allergy medication.  She had already called her primary care doctor and informed them of her symptoms. She wanted to know if this was related to the vaccine she had received and I told her that it was possible but that I would like to call her back after I spoke with the protocol physician regarding the situation. I informed her that I was going to call the protocol physician immediately.  She said that was okay and gave me a phone number to call her back.  I called the protocol physician's office at approximately 2:30pm to let them know that a potential adverse reaction may have occurred and the receptionist informed me that unless she was actually a patient of doctor, there was nothing they would be able to do.  I then called the patient's primary care physician, and spoke with someone at approximately 2:35pm.  I informed her that I was aware of what the patient had called them regarding and that she had called me as well.  She said she would give the information to doctor and took the number of the pharmacy for him to call.  I called the patient back at approximately 3:00pm on 4/9/15 and she informed me that she was feeling better but her stomach still felt a little upset and she was still light headed.  She also noted that the site reaction seemed to be improving and was not as red, raised and painful as it had been earlier. She described it as being more like a bruise now but still being a little tender.  I advised her to apply ice to the site reaction to help with pain, redness and swelling.  I also advised her to make sure she was drinking plenty of fluids due to the bowel movements and the vomiting.  I informed her that the symptoms she was experiencing could have been due to the vaccine (headache, diarrhea, nausea, flu-like symptoms, injection site reaction).  My source for confirming this information was Facts and Comparisons.  I also informed the patient that should her symptoms worsen or persist beyond 1-2 days she should again call doctor's office.  As of 8:15pm on 4/9/15 I have not received any reply from doctor's office.  Both pharmacy supervisor and immunization coordinator had also been notified by 3:15pm on 4/9/15.