Age: 63.0
Sex: M
Vaccine: VARZOS
Symptoms: Herpes simplex serology negative, Macrocephaly, Nuclear magnetic resonance imaging brain normal, Red blood cells CSF positive, Tinnitus
Clinical narrative: Information has been received from a registered nurse concerning a male who was vaccinated with a dose of Zostavax. Subsequently three days after vaccination, the patient developed hearing loss. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested. Follow up information was received from the registered nurse and medical records on 25-JUN-2007. It was noted that the patient, a 62 year old semi-retired male with no known allergies, cranial nerver VII palsy, long standing stable right-sided hearing loss secondary to gunfire exposure in the mid 1960's and a history of Lyme's disease in June 2006 treated with 21 days of antobiotics, a herniorrhaphy and knee arthroscopy was vaaccinated SC on 22-MAR-2007 with a first dose of ZOSTAVAX ) lot # 656394/0162U). There was no illness at the time of vaccination. Concomitant therapy includd folic acid. On 28-JUN-2007 the patient had an outpatient visit with an ENT where he reported a 3-day history of new onset left-sided hearing loss. The patient stated that on the morning of 25-MAR-2007 he woke up and noticed he couldn't hear out of the left side. There was minimal faint very mild imbalance when he moved his head but no vertigi and no obvious dysequilibrium. The patient had no recent illness and he felt otherwise very well. The patient had no prior otologic history. The patient also had intermittent left sided tinnitus as a bell tone lasting several seconds and then resolving, this was new for the patient. An audiological evaluation performed on this date showed profound left-sided sensorineural hearing loss., flat across all frequencies sensorineural hearing loss with normal low-frequency range. Speech reception threshold: RE: 10ds, LK, 100+; Speech discrimination: RE: 96%, LE: cannot test; tympanograms: RE: Type A, LE: Type A; acoustic reflexes: RI; intact, LI;l absent. It was reported that the patient's hearing loss had an unclear etiology but the most probable etiology was viral syndrome., it was also wondered if this was a manifestation o fthe patient's Lyme's disease. The patient was started on a 3 week tapered course of PREDNISONE. The patient was seen again on 04-APR-2007 at the time it was noted that the patient still had mild residual left-sided cranial VII palsy from "last summer" but it was noted that the patient had new left eyelid and lower jaw movement irregularity over the "past week". A brain MRI was reportedly negative for any structural lesion. A lumbar puncture was scheduled for 05-APR-2007. The following labs were collected on 05-APR-2007, Varicella zoster DNA PCR - not detected; Herpes simplex virus 142 DNA real time PCR of CSF - HSV DNA not detected, HSV 1 not detected, HSV 2 not detected; Lyme disease DNA real time PCR from CSF/synovial fluid - not detected; Lyme disease antobody panel from CSF - antibody not detected. Veneral disease research lab of CSF - non reactive; CSF glucose - 70 mg/dl; CSF protein - 47 mg/dl; CSF culture - no organisms seen. On 01-MAY-2007 the patient had follow-up appointment, at that time it wasnoted that there was a slight improvement in his hearing since his first dexamethasone injection. On this date the patient had his second dexamethasone injection. Additional information received from the registered nurse on 05-JUL-2007 indicated that the patient was enrolled in a therapeutic program and has gotten some hearing back. The patient's hearing loss was considered diabling and not related to vaccination. No further information was available. Additional information has been requested. All available  medical records will be provided upon request.