Age: 74.0
Sex: F
Vaccine: VARZOS
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Blister, Blood creatine phosphokinase increased
Clinical narrative: Muscle weakness; weakness; Became red / Eventually the redness and blisters spread to her chest, shoulders, back and face.; Developed elevated CPK enzymes levels; Rash containing macular patches; Injection site redness; Injection site blister; Developed some blisters / Eventually the redness and blisters spread to her chest, shoulders, back and face.; Area was itchy; Area was hot; Painful; This case was reported by a pharmacist via call center representative and described the occurrence of macular rash in a 74-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   Co-suspect products included methylprednisolone sodium succinate (Solumedrol) for an unknown indication.   The patient's past medical history included asthma and hypothyroidism.   In July 2019, the patient received the 1st dose of Shingrix .5 ml and Solumedrol (intravenous) 60 mg twice daily (120 mg daily). In July 2019, 7 days after receiving Shingrix, the patient experienced macular rash (serious criteria hospitalization), injection site erythema (serious criteria hospitalization), injection site blisters (serious criteria hospitalization), blister (serious criteria hospitalization), pruritus (serious criteria hospitalization), skin warm (serious criteria hospitalization) and injection site pain. On 26th August 2019, the patient experienced creatine phosphokinase increased (serious criteria hospitalization). On an unknown date, the patient experienced localized erythema (serious criteria hospitalization), muscle weakness (serious criteria hospitalization) and weakness (serious criteria hospitalization). The patient was treated with valaciclovir hydrochloride (Valtrex), cefalexin (Keflex), topical steroid nos (Topical Steroids) and topical steroid nos (Steroid Cream). On an unknown date, the outcome of the macular rash, injection site erythema, injection site blisters, localized erythema, blister, pruritus, skin warm, creatine phosphokinase increased, muscle weakness, weakness and injection site pain were unknown.   It was unknown if the reporter considered the macular rash, injection site erythema, injection site blisters, localized erythema, blister, pruritus, skin warm, creatine phosphokinase increased, muscle weakness, weakness and injection site pain to be related to Shingrix.  Additional details were received as follows:  On 10th July 2019 or 12th July 2019, the patient received a dose of Shingrix at the pharmacy. The reporter did not sure of date of vaccination. The injection was very painful.  One week after vaccination, where the patient had the vaccine, it became red and developed some blisters. Eventually the redness and blisters spread to the patient's chest, shoulders, back and face. Less than three weeks, after vaccination, the area was itchy and hot. The patient went to the primary care physician (PCP) who prescribed steroid cream. But, it did not help so she went to dermatologist who prescribed Keflex and Valtrex. The dermatologist did not think it was shingles but prescribed these since there had been no improvement. There was no improvement. On 26th August 2019, the patient presented to the emergency room where the patient was administered intravenous steroids on then tapered off on 1st September 2019.  The patient developed elevated creatine phosphokinase (CPK) enzymes levels.  They were not sure, if it was due to the reaction or to the steroids. On 26th August 2019, the patient was admitted to the hospital due to muscle weakness and skin lesions which were at injections site, arms, chest, shoulders, back and face. The CPK level on admission to hospital was 8594. At the time of reporting, the patient was off topical steroids, IV steroids, Keflex and Valtrex. The reporter was unsure if patient was experiencing muscle weakness or weakness.