Age: 67.0
Sex: M
Vaccine: VARZOS
Symptoms: Arthralgia, Balance disorder, Blood sodium decreased, Chromaturia, Diet refusal
Clinical narrative: Copied from Admission note: Patient is a 67 year old white gentleman with a past med hx sig for HL, HTN, COPD, OA, Dep, and carcinoma of tonsil who was trassferred to Hospital for ARF and rhabdomyolysis.  Patient states that he received the Zostavax immunization on Monday 11-19-07.  On Wednesday 11-21-07, he began to feel bad.  He states that he lost his balance and fell.  This went away.  On Thursday 11-22-07 he developed a severe sore throat.  He took some mouthwash that he had left over from when he was receiving treatment for tonsillar cancer and this helped.  He also felt some nausea on Thursday.  On Friday 11-23-07, he developed right knee pain and could not get up out of bed.  He wanted to "wait it out over the weekend" but felt horrible this am.  He developed joint and muscle aches in his forearms, shoulders, ankles, and right knee so he went to the hospital today Sunday, 11-25-0. He has not slept in 4 days.  He has not eaten since Wednesday.  He denies any visual changes or headches.  He denies any vomiting or diarrhea/constipation.  Denies fevers or chills.  Denies abd or back pain, sob, change in cough.  States that he went to the hospital and they gave his IVF.  He did urinate 200cc of brown urine there.  Before that, he had not urinated since Friday.  Currently he c/o joint aches and pains.  Says that he does not feel up to walking around because he does not trust himself.  Labs that were done in  Lincoln includ: WBC 6.29  Hgb14.9  Platelets 156  band neut 77% segs 17% lymph 2%.  Na 125 K 4.1 Cl 89 Co2 19 BUN 51 Creat 3.8  Glu 103 Ca 8.9.  May 2.3 ESR 17. CK 5225, CKMB 109.4, RI 2.1.  Myoglobin >4000 Trop .67.  CT of head done which was neg for acute problem - did show mild atrophy.  Blood cultures drawn. UA performed and was yellow, slightly cloudy, sp grav >1.030, ph 5, prot 30, trace blood.  Patient states that he does not use oxygen at home for COPD and occ uses inhalers.  Has not had PFTs done.  Did have an adenosine cardiolyte 2/06 which showed EF of 58% and small fixed perfusion defect and no reversible defect.    12/11/07 Reviewed ER medical records of 11/25/07 which reveal patient experienced weakness.  States patient had received pneumonia, flu & shingles vaccinations on 11/20/07.  Developed sore throat, decreased appetite, dry cough, nausea & loss of balance w/multiple falls starting 11/22/07.  Developed generalized body aches, weakness & difficulty walking.  Had to lift right leg w/hands due to weakness. Transferred to higher level of care. FINAL ER DX: rhabdomyolysis w/renal failure & weakness.  1/29/08 Reviewed hospital medical records of 11/25/07 which reveal patient transfered from outlying ER for acute renal failure & rhabdomyolyis.  Records state zoster vax 7 days prior to admit & flu shot 2 weeks prior to admit.  Pst developed balance difficulty, falls, sore throat, nausea, joint pains, muscle aches, sleep disturbance, decreased appetite.  Admitted & shortly after admission found w/dusky face, stiff jaw, swollen neck, decreased air intake.  Intubated & CPR started.  Resuscitated & ABG revealed severe acidosis.  Transferred to ICU.  Developed v tach, resuscitated several times & eventually failed to respond. FINAL DX: Cardiopulmonary arrest; acute renal failure; rhabdomyolysis; HTN; hyperlipidemia; anxiety; COPD. 2/12/08 Reviewed autopsy report which states COD as septic shock w/acute rhabdomyolysis & renal failure.