Age: 62.0
Sex: F
Vaccine: VARZOS
Symptoms: Incomplete course of vaccination, Influenza A virus test negative, Injection site erythema, Injection site pain, Injection site swelling
Clinical narrative: At night on the day of vaccination, there was swelling, redness and pain at the site of injection, which continued for 10 days. On August 10, 2018 morning, when I woke up, I had a fever of 102.5 F which continued for 7 days. I took 2 tablets of Acetaminophen, 500 mg twice a day to control fever.  On December 1, 2018, while on a trip, I developed dry cough, fever and shortness of breath. I was given Acetaminophen to control fever, as needed, Azithromycin 500 mg for 5 days. On December 9, 2018, I was admitted to Emergency ward in the Hospital, with 73% oxygen saturation, fatigue, shortness of breath. X-ray showed severe damage to lungs and I was shifted to ICU where I was put on CPAP with 10 liters/minute oxygen. No bacterial infection or H1N1 flu were detected. However, I was given multiple antibiotics to treat for bacterial pneumonia and tamiflu to treat for pneumonia due to flu. None of these medicines improved my condition. Tests for malarial antigen, scrub typhus, leptospira, acid fast bacilli (tuberculosis), Pneumocystis carinii were negative. X-rays and CT scan taken during hospital stay showed sever damage to the lungs with fibrosis. A number of medicines were given with no benefit. I was started on 40 mg i/v methylprednisolone on December 13, 2018, increased to 1 g of methylprednisolone on December 17, 2018 for 3 days and bringing to 40 mg from December 20, 2018. Prednisolone continued until December 2019, when it was tapered down. On January 14, 2019, I was started with Azathioprine, 50 mg twice a day, which is still continuing. On February 1, 2019, I was discharged from the hospital with 24 hrs oxygen from a oxygen generator and taking prednisolone, 24 mg and Azathioprine 50 mg twice a day. On February 5, 2019, I cam back, was at the Hospital, on February 7, 2019 for 2 days due to shortness of breath. I consulted with a number of pulmonologists, including Dr who is currently treating me and pulmonologist.  I was diagnosed with Acute interstitial pneumonia leading to pulmonary fibrosis and type 1 respiratory failure at the hospital and Interstitial lung disease by the hospital, caused by a severe auto-immune reaction. I was enrolled for total lung transplant by the Hospital to which I refused due to personal reasons. I also consulted Rhematologist and Immunologist to rule out general autoimmune disease. None of the typical autoimmune factors came positive (ANA, dsDNA/ANCA all Negative). I believe that MPL and QS21 adjuvants present in Shingrix, produced high level of lipid A antibodies in my body after taking Shingrix Vaccine on August 9, 2018. MPL has been known to elicit antibodies against lipid A and presence of strong adjuvant QS 21 helped MPL to elicit very high levels of lipid A antibodies. There are a number of publications in 1990s that lipid A antibodies cross react with human muscles. These lipid A antibodies elicited a very strong inflammatory immune reactions in December 2018, about 4 months after taking the Shingrix vaccine and destroyed my lungs.  Due to the severe reactions, I did not take 2nd dose of Shingrix vaccine.