Age: 73.0
Sex: F
Vaccine: VARZOS
Symptoms: Arthropod bite, Biopsy, Erythema, Herpes zoster, Pain
Clinical narrative: Information has been received from medical assistant concerning a 75 year old female with an allergy to sulfa drugs who on 04-FEB-2009 was vaccinated with a dose of ZOSTAVAX (Merck) (lot # 658397/1820U). In August 2010 (also reported as "three weeks ago"), the patient experienced painful spots that were determined to be shingles on 18-AUG-2010. The patient came to office to seek medical attention. At the time of report, the patient's shingles persisted. Follow-up information has been received from the medical assistant which reported the patient was vaccinated SQ with a dose of ZOSTAVAX (Merck) into her left arm. The past medical history was unknown. On 28-JUL-2010, the patient experienced rash with pain, numbers of lesions at the left breast and left side of back and shoulder. The patient experienced herpes zoster. The maximum temperature test was not given. The patient had no recent exposure to chickenpox and shingles and had not rash at the site of injection post-vaccination. At the time of report, the patient was still having pain (also reported as recovered). The patient was enrolled in the Varicella Zoster Virus Identification Program to identify if VZV is present and if it is present, to identify if it is associated with the wild-type (WT) VZV strain or with the Merck vaccine strain. A lesion sample was collected on 02-SEP-2010 and sent to the laboratory on 07-SEP-2010. Follow up information has been received from VZV Identification Program on 13-SEP-2010. A lesion sample was collected on 02-SEP-2010. The sample was taken from a lesion on the patient's left thorax (none had blistery above). The VZV DNA and B-globin DNA was not amplified. The final result: Inadequate specimen, negative for B-Globin. No strain I.D obtained. At the time of reporting, the patient still had pain classified as 7 in a 1 to 10 scale. Follow up information has been received from a physician assistant via a medical record. It was reported that the 75 year old female patient with sulfa allergy and who was tobacco user, was vaccinated with a 0.65 ml dose of ZOSTAVAX (Merck). Past drug therapy included a dose of DECAVAC on 30-JAN-2008. Concomitant therapy included PREMARIN, omega-3 marine triglycerides, chondroitin sulfate sodium (+) glucosamine sulfate, calcium (unspecified), TUMS, flaxseed and cod liver oil. On 18-AUG-10, the patient presented to the clinic. She reported that she was golfing on approximately 28-JUL-2010 and felt a bug bite. Since that time, it had continued to be red, sore and somewhat itchy. Blood pressure was 132/58, pulse 72 and temperature 36.2 degrees C. The patient was alert and in NAD. Examination of the left T6 thoracic dermatome revealed a vesicular erythematous rash noted around the anterior aspect at the mid-abdominal region. No excoriations noted. No signs of infection were noted. There were several vesicles that were scabbed at that time. There were a couple of spots, one of them painful noted the day after golfing. It was reported that the patient was diagnosed with Herpes zoster despite ZOSTAVAX (Merck) one year ago. The patient was placed on ZOVIRAX 800 mg five times a day for seven days. It was discussed Gabapentin as well as steroids but patient would like to hold off at that time. On 25-AUG-2010, therapy with ZORIVAX was stopped. On 02-SEP-2010, the patient presented for a viral culture. It was reported that the patient had incidentally received a shingles vaccination in 2009. The patient presented for the culture of the lesions. Blood pressure was 136/72, pulse 84 and temperature 36.9 degrees C. The patient was well-nourished, well-developed female, alert and oriented in no acute distress. Examination of the skin revealed healing lesions, erythematous and in clusters extending from the left anterior chest to the left thoracic back. It was reported that the patient had shingles around left  breast, left side of back and around shoulders. The lesion's areas were cleansed, injected with XYLOCAINE with epinephrine for local anesthesia, two separate areas were unroofed and cultures were obtained at those sites. No further information is available.