Age: 71.0
Sex: F
Vaccine: RAB
Symptoms: Animal bite, Blister, Conjunctival hyperaemia, Erythema, Eyelid oedema
Clinical narrative: Initial report received on 19 December 2007 from another manufacturer, no corresponding report number provided. The reporter to this manufacturer had been the patient. A patient (age, gender, and date of birth not provided) had received an injection of rabies vaccine, manufacturer unknown, lot number not provided, on an unspecified date. On an unspecified date during the rabies vaccination series, the patient developed shingles. Additional information corresponding to the event was not provided. Recovery status was not reported. Follow-up information was received from the patient on 25 July 2008. Clinic Progress Notes, which were supplied by the patient, indicated that the 71-year-old female patient presented to the clinic on 08 September 2006 with a chief complaint of animal bite. Slightly less than two weeks prior, the patient had been walking her dogs when the dogs attacked a coyote puppy. The patient broke up the fight and was bitten on her hand by her dogs as well as the coyote. The dogs' rabies shots were up to date. On an unspecified date prior to 08 September 2006, the patient was seen by her physician, who initiated treatment with antibiotics. At that time, however, the patient did not relay the fact that she had been bitten by a coyote. When seen at the clinic on 08 September 2006, the patient denied any numbness, tingling or paresthesia around the bite site on her left hand. She denied any neurological symptoms. There were prior bite marks consistent with the patient's history. There was still a slight amount of erythema surrounding the wounds. The clinic started rabies post exposure prophylaxis. The patient was given rabies immunoglobulin and vaccination series (manufacturers, lot numbers not reported). When again seen at the clinic on 11 September 2006, the patient complained of possible shingles on her right eye. The patient has a chronic problem with dacrocystitis for which she has had bilateral eye surgery and for which she uses sulfacetamide solution when needed. The patient used the sulfacetamide solution for 2-3 days for this event, but stopped because there was no improvement. The patient reported some blurriness but no other visual changes. The patient denied any yellow or green drainage and did not know if she had photophobia. On exam, the patient had moderate edema of the upper lid with mild edema of the lower right eyelid. There was mild erythema of bulbar conjunctiva. It was also reported that on 09 September 2006, the patient began having blisters on her forehead which were painful and sometimes pruritic. The patient also described an itching painful rash on her right frontal scalp and right forehead. Diagnosis was herpes zoster with eye involvement. The patient was given a prescription for acyclovir 100mg (to take one table five times per day for 10 days) and Vicodin 5.500 #15 (to take one tablet every 4-6 hours as needed for pain). The patient was strongly encouraged to allow the clinic to make an appointment with another doctor (specialty not reported) for evaluation, but the patient declined. The patient was provided with the phone number of the physician and was strongly encouraged to make an appointment within 48 hours. The patient was to follow-up with the clinic the following day. A notation, hand-written by the patient, indicated that she recovered, but had slight corneal damage. Outcome was not mentioned in the Clinic Progress Notes. This case has been upgraded to serious based upon this new information received.