Age: 67.0
Sex: M
Vaccine: VARZOS
Symptoms: Asthenia, Cerebellar atrophy, Cerebral artery thrombosis, Cerebral infarction, Cerebrovascular accident
Clinical narrative: stroke/cerebral vascular accident; cerebral infarction, unspecified; Cerebral infarction due to thrombosis of right middle cerebral artery; left facial droop; slurred speech; hemiparesis affecting left side as late effect of stroke (HCC); chronic microvascular ischemic changes with mild cerebellar atrophy; hemiplegia; acute-subacute lacunar infarct; right-sided lacunar stroke; left side numbness; dizziness; This case was reported by a lawyer and described the occurrence of hemiparesis in a patient who received Herpes zoster (Shingrix) for prophylaxis.   The initial information was received on 12 June 2020 via medical records (case now medically confirmed). As per pharmacy record, on 14 August 2018 the patient received suspect Shingrix vial kit. As per medical record, the patient reports few days prior to hospital presentation on 16 August 2018 had received vaccine for shingles was not feeling well, generalized weakness, tiredness 2-3 days later he went to meet his friend at his work, friend noticed that his speech was slurred and was taken to the hospital for evaluation. The patient was weak in his left arm and left leg and patient's friend has noticed left facial droop. He was admitted to for stroke. He was noted to have left facial droop and slurred speech. The patient reports his symptoms have started to resolve within 8 hours of Admission and within 2-3 weeks most of his symptoms have resolved. He had MRI (Magnetic resonance imaging) of the brain which showed acute-subacute lacunar infarct in the subependymal white matter of the right cerebral hemisphere within the corona radiata, chronic microvascular ischemic changes with mild cerebellar atrophy. On 16 August 2018, the patient states he continues to had symptoms of left side numbness, difficulty walking, complains of not being able to grasp for long periods of time with left hand and states he feels slow and disconnected. The patient was admitted on 21 August 2018 and discharge on date 19 September 2018 for cerebral infarction, unspecified (admission diagnoses and final diagnoses). The patent diagnosis included right-sided lacunar stroke (HCC), hemiparesis affecting left side as late effect of stroke (HCC), hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. As per record, the patient positive for chest pain (described as burning mid-sternal discomfort), gait problem , dizziness and weakness. On 14 September 2018, the patient had echocardiogram 2d complete with contrast showed positive agitated saline bubble study for right to left shunting, likely at the pulmonary level. The patient was admitted on 27 September 2018 and discharge on date 27 September 2018 for Cerebral infarction due to thrombosis of right middle cerebral artery (admission diagnoses and final diagnoses). On 27 September 2018, the patient encounter diagnosis was Cerebral infarction due to thrombosis of right middle cerebral/ CVA (cerebral vascular accident) (HCC) (primary), Hemiparesis affecting left side as late effect of stroke (HCC).