Age: 9.0
Sex: F
Vaccine: VARCEL
Symptoms: Infection transmission via personal contact, Lipase normal, Mouth ulceration, Rash vesicular, Secondary transmission
Clinical narrative: Information has been received from a physician concerning an immunocompromised 9 year old female post renal transplant patient (1998) with liver disease and no allergies whose brother was vaccinated on approximately 16-MAR-2007 with a dose of Varivax. Concomitant therapy included LASIX, penicillin (unspecified), BACTRIM, prednisone,  ZANTAC, acyclovir, cyclosporine, and enalapril maleate (manufacturer unknown). On 02-APR-2007 the patient experienced abdominal pain and was hospitalized at that time. On 04-APR-2007, the patient developed Varicella lesions. The rash was vesicular and was over her face and trunk. The rash continued onto the extremities but to a lesser degree than compared to her face and trunk. She also had ulcers in her mouth, some of which were open. The patient was still having new lesions appear. There was no fever. The patient had an abdominal X-ray that was "normal" and a chest X-ray that reported left basilar atelectasis. The patient has "experienced significant incapacity due to the abdominal pain. " Laboratory test revealed sodium 144, potassium 4.4, BUN 50, creatinine 1.93, total bilirubin 0.2, amylase 86, lipase 72, alkaline phosphatase 222, ALT 55, and VZVIGG and VZVIGM were pending. As of 06-APR-2007, the patient continued to develop new lesions and the abdominal pain continued intermittently. The patient remained hospitalized. They were treating the patient with intravenous anti-virals until the lesions stopped occurring and became crusted over. Her current medications were also adjusted. It was noted that the patient's brother did not have any lesions present. The patient also had a school exposure to chickenpox at the same time but it was not known until after the patient was hospitalized. The patient had no history of ever having chickenpox herself but has had a history of receiving VZVIG a couple of times in the past due to possible exposure to chickenpox. At the time of the report, the patient had not recovered. A product quality complaint was not involved. The patient was enrolled in the VZVIP program: the Varicella Zoster Virus Identification Program enables biological samples to be analyzed by PCR to identify if VZV is present and if it is present to identify whether it is associated with the wild-type VZV strain or with the manufacturer vaccine VZV strain. Varicella, abdominal pain, and left basilar atelectasis were considered to be other important medical events and the event of abdominal pain was considered to be disabling by the reporter. Additional information has been requested.  Additional information ws received from the physician who reported that the patient's 22 month old (also reported as 12 months old) brother was immunized three weeks prior to the patient's illness. A rash did not occur at the vacinee's site of injection post vaccination and he had no reaction. A swab specimen was obtained from the patient on 06-APR-2007 from a vesicle lesion. On 02-APR-2007 the patient had abdominal pain and elevated liver transaminases. The patient did not have a fever. The patient developed a vesicular rash with many lesions on the face, mouth, trunk, and extremities. At the time of the report, the patient remained hospitalized.   Additional information was received from a health professional who reported that the patient was discharged from the hospital during the week of 09-APR-2007. The PCR results for the specimen identified the presence of wild type virus. Varicella, abdominal pain, and left basilar atelectasis were considered to be other important medical events and the event of abdominal pain was considered to be disabling by the reporter.