Age: 71.0
Sex: M
Vaccine: VARZOS
Symptoms: Diarrhoea, Dysuria, Fatigue, Herpes zoster, Pollakiuria
Clinical narrative: Information has been received from a Pharm D. concerning a 71-year-old male with rheumatoid arthritis who on 31-OCT-2007 was vaccinated with a dose of ZOSTAVAX (lot # 658395/0996U).  Concomitant therapy included methotrexate, PLAQUENIL and prednisone.  On 06-NOV-2007 the patient developed a rash which started on the chest wall (shingles).  On 08-NOV-2007 the patient became fatigued and experienced urinary incontinence, frequency and burning.  The patient sought medical attention by contacting the pharmacist.  At the time of the report the patient's status was not recovered.  The patient's wife was interested in VZV Analysis by PCR.  On 12-NOV-2007 it was reported "they did not know if there is enough specimen to scrape for the VZV ID program".  Additional information has been requested. 03/26/2008 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 strain or with the OKA/Merck vaccine VZV strain. The sample of the lesion was collected on 12-NOV-2007. The source and site of the specimen was not specified. The PCR results for the specimen identified the presence of the VZV WILD TYPE STRAIN. Follow-up information was received on 28-NOV-2007 froma physician concerning a 71-year-old male with rheumatoid arthritis, erectile dysfunction, hypertension, chronic lumbar muscle spasms, knee osteoarthritis, depression, resting tremor, osteopenia, spinal stenosis associated with muscle spasms, cardiac failure congestive, diabetes mellitus, obesity, lumbar laminectomy with fusion, alcohol use (occasionally), a sulfonamide allergy and a history of hiatal hernia, myocardial infarction, shoulder surgery (spurs-rotator cuff), tobacco use (quit FEB-2000), adenotonsillectomy and tonsillectomy who on 31-OCT-2007 was vaccinated in the left deltoid with a 0.5 ml dose of ZOSTAVAX (Oka/Merck) (lot # 658395/0966U). Concomitant therapy included methotrexate, PLAQUENIL, prednisone, ATENOLOL (MSD), acetaminophen (+) codeine (manufacturer unspecified), carisoprodol (manufacturer unspecified), calcium (manufacturer unspecified), vitamin E (manufacturer unspecified),  ascorbic acid (manufacturer unspecified), folic acid (manufacturer unspecified), vitamin D (manufacturer unspecified), magnesium (manufacturer unspecified), dimethyl sulfone (manufacturer unspecified), glucosamine (manufacturer unspecified), AVENTYL and vitamins (manufacturer unspecified). On 06-NOV-2007 the patient developed five blister type lesions on the left rib cage. It was reported the patient broke out in an obvious patch of shingles on the chest with no other disseminated lesions. The patient did not have a systemic fever, sore throat, cold or arthralgias, lungs was clear, heart tones normal, throat was not red and nasal mucosa was a bit erythomatous. He did have an episode of urinary frequency and pain, but the patient had been on two different antibiotic courses for his sinusitis. The physician reported that the patient's shingles is getting better on its own (three days from the onset) so he will not treat the patient with acyclovir. He will obtain a UA and C&S to see what is going on in the urine and treat if positive. The patient was referred out to a rheumatologist regarding his greater than 10 years methotrexate and prednisone use. On an unspecified date the patient recoverd from shingles. Information received on 28-NOV-2007 contained the following adverse events: sinusitis, diarrhea (08-NOV-2007). Additional information is not expected.