Age: 90.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Malaise, Mammogram normal, Musculoskeletal chest pain, Nausea, Oedema
Clinical narrative: This spontaneous report as received from a physician via medical records refers to a non smoker 91 year old female patient with gastrooesophageal reflux disease, osteoporosis, diabetes mellitus type 2, sinusitis acute, TMJ syndrome, upper respiratory infection, vertigo/dizziness, costochondritis, cough, dysuria, lumbago, otitis media, acute serous, strain of hip, wheeze, penicillin allergy, shrimp allergy, sulfur allergy and iodian allergy. Oesophagogastroduodenoscopy was performed on 16-NOV-2011 where it was found a mild esophageal dysmotility (barium swallow). The patient's medical history included chicken pox as adult. Historical vaccinations included FLULAVAL on 14-NOV-2011 and 21-NOV-2011, FLUZONE on 08-NOV-2013 and 22-NOV-2013 and pneumococcal vaccine (unspecified) (manufacturer unknown) on 25-JUL-2013. On 26-AUG-2013, the patient was vaccinated with a dose of ZOSTAVAX (Lot #, J003796, expiration date 28-JUN-2014) (route not reported) in the right upper arm. Concomitant therapies included LASIX, aspirin, ubidecarenone, lidocaine, acetaminophen, PERCOCET, valsartan, simvastatin (manufacturer unknown), ergocalciferol, fluticasone, furosemide and meclizine. The physician reported that on 11-SEP-2013, the patient experienced pain in soft tissues of limb. On 29-OCT-2013, the patient experienced edema. On 08-NOV-2013, the patient experienced atrial fibrillation and congestive heart failure. On 22-NOV-2013, the patient experienced overactive bladder. On 16-APR-2014, the patient experienced allergic rhinitis and rib pain on left side. On 18-MAR-2014, the patient's mammogram was normal. On 03-JUN-2014, the patient experienced pain in joint, shoulder region, shoulder bursitis and non venomous arthropod bite, tick bite. The physician reported that on 22-JUL-2014, the patient also experienced shingles rash and was hospitalized on the same day for 5 days (also reported as 4 days). The patient complained of fatigue and malaise as systemic symptoms but denied chills, diaphoresis, fever, insomnia, night sweats, recent illness and weight loss. The patient presented to hospital with an urinary tract infection (UTI), still a lot of pain and was getting itchy, blisters, varicella zoster rash right T10 dermatone, still with rash (too numerous to count). The rash was located on the chest right side of chest cover the T10 dermatone and on the right lower chest. The quality was acute, improving, burning, painful and popular. It was described as erythematous. The symptom was sudden in onset and gradual resolution. The patient was constipated from medications. On 27-JUL-2014, the patient was discharged from hospital with medications reconciliation was done. No follow up other that visit on 05-AUG-2014 was done. The patient had ambulation status fully ambulatory and self care able to care for self. On 05-AUG-2014 visit, the patient presented with hyponatremia/hyposmolality. Found to be hyponatremic while hospitalized. The quality was   [Due to memory limitations, the remainder of this text could not be compared.]  was acute. The symptom was sudden onset and gradual in resolution. The symptoms began in July 2014 2 weeks ago. The sodium level was 5 units below normal. The patient next presented with dysuria. Found to have a UTI while hospitalized. The quality was improving. The symptom was sudden onset and gradual in resolution. The patient also experienced hyperlipidemia mixed and essential hypertension. On an unknown date, the patient experienced unspecified vaginitis and vulvovaginitis and nausea. The patient's review of systems was normal except for dermatologic which showed itchy rash and rash (groups of vesicles on an erythematous base over the right T10 dermatone) but denied scar. The patient's body mass was 24.803, temperature was 36.0 degrees C tympanic, and her blood pressure was 110/74 mmHg in the left arm sitting. The patient's maximum temperature was 37.7 degrees C. The patient's physician examination was normal except for integument. The inspection of skin showed dermatitis (weeping vesicular, erythema and thickened), location was chest right T10 dermatone, rash lesions were vesicle groups of vesicles on an erythematous base over the right T10 dermatone and linear vesicular eruptions. The patient was diagnosed with herpes zoster: shingles, hyponatremia and urinary tract infection. The patient was treated with oxycodone, acetaminophen 5 mg-325 mg tablet, 1 tablet per oral, QID for a total of 30 and start on 05-AUG-2014. The patient was instructed to continue VALTREX and gabapentin, also refilled acetaminophen, PERCOCET, use as needed for pain, reassured that the patient would subside but night take time. A sample from vesicle lesions was collected. The outcome of shingles rash and urinary tract infection was reported as recovering/resolving. The outcome of acute hyponatremia/hyposmolality, pain in joint shoulder region, nausea, congestive heart failure, unspecified vaginitis and vulvovaginitis, shoulder bursitis, rib pain on left side, pain soft tissues of limb, overactive bladder, non venomous arthropod bite, tick bite, hyperlipidemia mixed, essential hypertension, edema, allergic rhinitis and atrial fibrillation was reported as not recovered/not resolved. The outcome of constipated from medications was unknown. All available medical records will be provided upon request. Additional information has been requested.      This spontaneous report as received from a physician via medical records refers to a non smoker 91 year old female patient with gastrooesophageal reflux disease, osteoporosis, diabetes mellitus type 2, sinusitis acute, TMJ syndrome, upper respiratory infection, vertigo/dizziness, costochondritis, cough, dysuria, lumbago, otitis media, acute serous, strain of hip, wheeze, penicillin allergy, shrimp allergy, sulfur allergy and iodian allergy. Oesophagogastroduodenoscopy was performed on 16-NOV-2011 where it was found a mild esophageal dysmotility (barium swallow). The patient's medical history included chicken pox as adult. Historical vaccinations included FLULAVAL on 14-NOV-2011 and 21-NOV-2011, FLUZONE on 08-NOV-2013 and 22-NOV-2013 and pneumococcal vaccine (unspecified) (manufacturer unkown) on 25-JUL-2013. On 26-AUG-2013, the patient was vaccinated with a dose of ZOSTAVAX (Lot # J003796, expiration date 28-JUN-2014) (route not reported) in the right upper arm. Concomitant therapies included LASIX, aspirin, ubidecarenone, lidocaine, acetaminophen, PERCOCET, valsartan, simvastatin (manufacturer unknown), ergocalciferol, fluticasone, furosemide and meclizine. The physician reported that on 11-SEP-2013, the patient experienced pain in soft tissues of limb. On 29-OCT-2013, the patient experienced edema. On 08-NOV-2013, the patient experienced atrial fibrillation and congestive heart failure. On 22-NOV-2013, the patient experienced overactive bladder. On 16-APR-2014, the patient experienced allergic rhinitis and rib pain on left side. On 18-MAR-2014, the patient's mammogram was normal. On 03-JUN-2014, the patient experienced pain in joint, shoulder region, shoulder bursitis and non venomous arthropod bite, tick bite. The physician reported that on 22-JUL-2014, the patient also experienced shingles rash and was hospitalized on the same day for 5 days (also reported as 4 days). The patient complained of fatigue and malaise as systemic symptoms but denied chills, diaphoresis, fever, insomnia, night sweats, recent illness and weight loss. The patient presented to hospital with an urinary tract infection (UTI), still a lot of pain and was getting itchy, blisters, varicella zoster rash right T10 dermatone, still with rash (too numerous to count). The rash was located on the chest right side of chest cover the T10 dermatone and on the right lower chest. The quality was acute, improving, burning, painful and popular. It was described as erythematous. The symptom was sudden in onset and gradual resolution. The patient was constipated from medications. On 27-JUL-2014, the patient was discharged from hospital with medications reconciliation was done. No follow up other that visit on 05-AUG-2014 was done. The patient had ambulation status fully ambulatory and self care able to care for self. On 05-AUG-2014 visit, the patient presented with hypoatremia/hyposmolality. Found to be hyponatremic while hospitalized. The quality was acute.   [Due to memory limitations, the remainder of this text could not be compared.]  acute. The symptom was sudden onset and gradual in resolution. The symptoms began in July 2014 2 weeks ago. The sodium level was 5 units below normal. The patient next presented with dysuria. Found to have a UTI while hospitalized. The quality was improving. The symptom was sudden in onset and gradual in resolution. The patient also experienced hyperlipidemia mixed and essential hypertension. On an unknown date, the patient experienced unspecified vaginitis and vulvovaginitis and nausea. The patient's review of systems was normal except for dermatologic which showed itchy and rash (groups of vesicles on an erythematous base over the right T10 dermatome) but denied scar. The patient's body mass index was 24.803, temperature was 36.0 degrees C tympanic, and her blood pressure was 110/74 mmHg in the left arm sitting. The patient's maximum temperature was 37.7 degrees C. The patient's physician examination was normal except for integument. The inspection of skin showed dermatitis (weeping vesicular, erythema and thickened), location was chest right T10 dermatone, rash lesions were vesicle groups of vesicles on an erythematous base over the right T10 dermatone and linear vesicular eruptions. The patient was diagnosed with herpes zoster: shingles, hyponatremia and urinary tract infection. The patient was treated with oxycodone, acetaminophen 5 mg-325 mg tablet, 1 tablet per oral, QID for a total of 30 and start on 05-AUG-2014. The patient was instructed to continue VALTREX and gabapentin, also refilled acetaminophen, PERCOCET, use as needed for pain, reassured that the pain would subside but might take time. A sample from vesicle lesions was collected. The outcome of shingles rash and urinary tract infection was reported as recovering/resolving. The outcome of acute hyponatremia/hyposmolality, pain in joint, shoulder region, nausea, congestive heart failure, unspecified vaginitis and vulvovaginitis, shoulder bursitis, rib pain on left side, pain in soft tissues of limb, overactive bladder, non venomous arthropod bite, tick bite, hyperlipidemia mixed, essential hypertension, edema, allergic rhinitis and atrial fibrillation was reported as not recovered/not resolved. The outcome of constipated from medications was unknown. All available medical records will be provided upon request. Additional information has been requested.                      Adjudication Data Entry