Age: 69.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site pain, Lyme disease, Pyrexia, Rash, Rash erythematous
Clinical narrative: cellulitis; redness at the injection site; injection is still sore/pain; Lyme's disease; low grade fever; chills; rash on her left side of her face, left side of neck/spots on her back/edness on her left side of her face,  left side of neck and also a red circle around her left arm pit.; This case was reported by a pharmacist via call center representative and described the occurrence of cellulitis in a 69-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis.   The patient's past medical history included lymph node excision (right side), cancer and cancer pain. Previously administered products included Shingrix with an associated reaction of injection site pain (1st dose received on 17th April 2019 and experienced injection site pain refer case US2019AMR132491).   On 21st June 2019, the patient received the 2nd dose of Shingrix. In June 2019, less than a month after receiving Shingrix, the patient experienced red rash. On 21st June 2019, the patient experienced lyme disease (serious criteria GSK medically significant), low grade fever, chills and injection site pain. On 24th June 2019, the patient experienced injection site erythema. On an unknown date, the patient experienced cellulitis (serious criteria GSK medically significant). The patient was treated with ibuprofen, cephalexin (Keflex) and doxycycline. Rechallenge with Shingrix was positive. On an unknown date, the outcome of the cellulitis, low grade fever, chills, injection site erythema and red rash were recovered/resolved and the outcome of the lyme disease was unknown and the outcome of the injection site pain was not recovered/not resolved.   It was unknown if the reporter considered the cellulitis, lyme disease, low grade fever, chills, injection site erythema, red rash and injection site pain to be related to Shingrix.  Additional details were provided as follows: The retired pharmacist reported this case for herself. The patient was under 130 pounds. The patient experienced pain with Shingrix that was worse than cancer which she had in the past. On the same day, the patient also experienced low grade fever and chills. Three days after receiving Shingrix, the patient experienced redness at the injection site that moved down her arm.  The redness was almost like an outline of a darker red around it. The patient clarified that she received the injection on her left arm because she still had lymph nodes on that side of her body. Her lymph nodes were removed from right side prior of receiving Shingrix. Less than a month after receiving Shingrix, the patient also experienced rash and redness on her left side of her face, left side of neck and also a red circle around her left arm pit.  The patient then visited the clinic. The patient received ibuprofen and water. On 8th July 2019, she went back to clinic and the physician assistant (PA) said that she had cellulitis and prescribed Keflex 3 times a day for a week. Everything was starting to resolve.  On 12th July 2019, going into 13th July 2019, the redness acted up. She felt like the rash was coming back in the same places. On 15th July 2019, the doctor told her that she had some spots on her back and the physician thought that she had Lyme's disease.  The patient received Doxycycline for rash.  However, the patient did not believe that she had Lyme's disease as she was not outdoors. At the time of reporting, the arm where the patient received Shingrix was still sore. On 15th July 2019, the patient underwent blood test and the doctor was trying to determine the diagnosis from it.  On 22nd July 2019, the patient would visit the doctor. The reporter consented to follow up. The pharmacist wanted to speak directly to medical information. The pharmacist was unable to ask her if the company could follow up with her physician.