Age: 82.0
Sex: F
Vaccine: VARZOS
Symptoms: Viral DNA test negative, Wound secretion
Clinical narrative: This is in follow-up to report(s) previously submitted on 9/24/2008. Information has been received from a physician and office records concerning an 83 year old female, weight 167lb 2oz, with chronic obstructive disease (asthma), type 2 diabetes mellitus with neurological manifestations and peripheral vascular disorders, increased lipids, hypercholesterolemia, osteoarthritis, gout, sciatica, acquired spondylolisthesis, spasm of muscle, pityriasis versicolor, neuralgia, plantar fascial fibromatosis, essential hypertension, pain in limb and lumbago and allergies to penicillin, KEFLEX (caused rash) and codeine (caused nausea), no recent exposure to chickenpox or Shingles, and a history of status asthmaticus, hysterectomy, cellulitis and abscess of unspecified digit and leg and bunion who in the afternoon of 15-FEB-2008 was vaccinated with ZOSTAVAX (Oka/Merck) (lot#: 659759/1873U) 1ml SQ in the left deltoid. There was no illnesses at the time of the vaccination. Concomitant therapy included ADVAIR, ZANTAC, albuterol, magnesium hydroxide, FLONASE, CRESTOR, LOTREL, LASIX, allopurinol, hydralazine, PROVENTIL HFA, AVALIDE. Subsequently, in approximately April 2008 the patient developed blisters on left lower extremity which were initially treated as cellulitis, but later manifested as a blistering weeping rash and gradually spread to the entire body. The patient was seen in the office and was prescribed VALTREX, acyclovir, NEURONTIN. After three months had passed since her symptoms began the patient had not improved. On 21-JUL-2008 the patient was seen by the physician in the office for a follow-up evaluation of a left leg rash. The rash was slowing improving however she had blistering on her palmer aspect of her hand and increased swelling of her right leg as well. She had been developing random nonspecific pruritic spots on the upper extremity and back. The patient continued to have a rash on both legs. The patient was taking DARVOCET N100 and felt some relief without adverse reaction. Her physical exam noted a female in no apparent distress. Her blood pressure was 152/69 and pulse oximetry of 96%. Her skin was warm and dry and had good skin turgor. There were various lesions on the body; upper and lower extremities were observed. There were no other abnormalities noted on physical exam. There were no diagnostic tests performed. The physician's impression was disseminated varicella zoster. The treatment plan included wound care instructions and an increase in gabapentin to 300 mg capsule, two capsules twice a day and continue acetaminophen (+) propoxyphene napsylate 100 mg tablet, one twice a day as needed. She was to return in two weeks for a follow-up visit for the rash. As of 23-JUL-2008, the patient's rash persisted on both legs. The patient was enrolled in the Varicella Zoster Virus Identification Program to identify if VZV is present and if it is present to identify if it is associated with the wild-type VZV strain or with the OKA/Merck vaccine VZVA strain. On 02-AUG-2008, a specimen was obtained from a vesicle type lesion on her foot/ankle. PCR results indicated there was inadequate specimen, no strain identified. Follow up information was received from the physician's office. It was reported that the patient was not hospitalized. The patient had a rash all over her body (>10) and the physician's diagnosis was rash (Previously reported as disseminated herpes zoster in medical records). The patient was referred to a dermatologist. Additional information has been requested.