Age: 41.0
Sex: M
Vaccine: SMALL, TYP
Symptoms: Astigmatism, Condition aggravated, Eye pain, Keratitis, Ocular hyperaemia
Clinical narrative: This case was received on 12 February 2014 via a third party query tool search on the VAERS database, under reference number 511739. Note: There may be a discrepancy between the event date fields and the onset date information in the free text narrative field in the data reported. Latency has been calculated using the event date reported by VAERS. A 41-year-old male patient received the following vaccinations on 08 February 2013 (also reported as 18 February 2013): ACAM2000 (lot number VV04003A), and VIVOTIF (Berna, lot not reported). Medical history included presbyopia, regular astigmatism, superficial keratitis, knee pain, asymmetrical sensorineural hearing loss, dermatitis, spondylolisthesis, herpes simplex (cold sores since 2009, treated with ZOVIRAX then with acyclovir) and MRSA (methicillin resistant staphylococcus aureus, 2009). The patient reported 20/20 vision in both eyes prior to vaccination, and denied touching his eyes after dressing changes. His vaccination site progressed normally, with a normal site reaction per the reported. Five days post-vaccination, on 13 February 2013 (also reported as 18 February 2013), the patient reported he could not read large highway signs while driving, and had to close his left eye 1/2 way in order to have clear vision. A few days later he reported similar symptoms in his right eye. On 01 March 2013 (reported as 10 days post-vaccination), the patient presented to the optometry clinic complaining of "major changes in left eye vision". He was noted to have 20/25 vision in the left eye with diffuse superficial keratitis of the cornea "with RTBUT and left eye showing oblique scar through pupil from 2-8 superior mid pupil, otherwise normal eye exam" with no pustules, lesion, abrasions or other abnormalities. Optical tomography showed "temp thickening of macular zone" of the left eye; right eye was fine. He was diagnosed with astigmatism, presbyopia, and superficial keratitis of the left eye, and prescribed prednisolone 1% ophthalmic suspension drops. He was seen in follow-up on 08 March 2013 (reported as 17 days post-vaccination), and at that time complained of painful redness in the left eye, for which he was treated unsuccessfully with lubricant eye drops (pain 3/10). On 11 March 2013 he noted that his eyes "felt better but still hurt". A slit lamp exam again showed diagonal scar through the left eye line of sight with right eye 20/20 and left eye 20/20 + 1.00; the patient denied any injury or surgery. He was instructed to taper the ophthalmic steroids over the next 10 days. On 05 June 2013 he was seen by a flight surgeon for "SFFP aviation physical" prior to resuming flying, for which he was required to have 20/20 vision bilaterally. At that time he was given a refill for acyclovir, which he had taken previously for outbreaks of herpes simplex virus (outbreaks since 2009, frequency not reported). He completed his "SFFP aviation physical" on 25 June 2013. A follow-up noted date 01 July 2013 stated that the patient "wants a second opinion; currently denies any issues with distance vision". Visual exam at that time: 20/25 left eye, 20/20 right eye, 20/20 bilaterally. He was diagnosed with presbyopia and referred to the ophthalmology clinic at that time. Outcome was reported as recovered. Documents held by sender: none.