Age: 10.0
Sex: M
Vaccine: VARCEL
Symptoms: Meningitis, Mouth ulceration, Neck pain, Pain, Pyrexia
Clinical narrative: Information has been received from a physician concerning a 10 year old male with a history of varicella exposure (at 2 months of age) and chicken pox (one lesion) who on an unspecified date was vaccinated with varicella virus vaccine live. On 5/25/04 the patient was seen by his health care provider and prescribed acyclovir for blisters. No recent exposure to chicken pox or shingles was noted. On 5/28/04 the patient was seen by the reporting physician with blisters on his right face. The patient also had a fever, meningeal signs, severe headache and vesicular lesions in his right external ear canal. The patient's condition was also described as herpes zoster characterized by open lesions in the mouth. A lumbar puncture was done on 5/28/04 and the CSF measurements were as follows: 240 WBC, normal glucose and normal protein. The patient was admitted to the ICU. MRI and EEG were normal. DFA of skin lesions was positive for VZV. CSF was sent to a clinic and VZV grew. The patient recovered from his herpes zoster and meningeal signs. As of 6/7/04 the patient was on day 10 of acyclovir and would be discharged home with four days of IV acyclovir ordered. No product quality complaint involved. It was noted that there was no rash at the site of injection or elsewhere within 42 days of the vaccination. The date of the herpes zoster was 5/26/04. The patient was noted to have approximately 25 lesions on the right of his face (noted to be the right facial zoster). His maximum temperature was 102 degrees. The patient quantified his pain as a 7, with 0 being the least and 10 being the most. Other systemic symptoms included neck pain, headache, and meningitis. It was noted that the patient recovered. There was no history of chicken pox. There was no recent exposure to chicken pox or herpes zoster or shingles. A direct fluorescent antibody was done and was positive for VZV. CSF was positive for VZV and has been sent for typing. No photo was taken. No further information is expected.  Follow up on 07/09/04 states: "Follow up information indicated that the CSF specimen was obtained on 05/28/04, was sent to a university lab on 06/07/04, and arrived in the lab on 06/08/04. VZV DNA was not amplified. The interpretation from the university lab was: adequate specimen, no VZV identified-negative. No further information is expected."  Follow up on 07/19/04 states: "Follow up information indicated that the CSF specimen was obtained on 05/28/04, was sent to a university lab on 06/07/04, and arrived in the lab on 06/08/04. VZV DNA was not amplified. The interpretation from the university lab was: adequate specimen, no VZV identified-negative. Additional information was received from the physician who indicated that regarding the CSF specimen, the clinic detected VZV using PCR analysis. That was the same specimen that was then sent to the university lab for testing. The physician indicated that attempts would be make to see if the clinic still has the specimen, in which case, it would be transferred to the university lab. The reporter also indicated that the child was immunized at one year of age and believes that he actually did have exposure to chickenpox and one blister as reported by the mother at "two months or two years of age."  This was never confirmed by a physician. While the pt, who was reportedly healthy and with a normal immune system, was recovering with treatment from the dermatomal herpes zoster on his right face/right ear and the meningeal signs, he also developed contralateral chickenpox lesions on his chest and back. The pt has subsequently fully recovered. No further information is expected."