Age: 76.0
Sex: F
Vaccine: VARZOS, FLU3, VARZOS
Symptoms: Chest X-ray normal, Musculoskeletal chest pain
Clinical narrative: This medically confirmed spontaneous report (initial receipt: 07-Sep-2011) concerns a 76 year-old female patient, who had a past medical history of rhizotomy surgery at L5-S1 in May-1980, bilateral bronchiectasis w/o ac exac (without acute exacerbation), hemoptysis and multiple drug allergies (ALLANTOIN, bacitracin, bacitracin zinc, polymyxin B, polymyxin B sulfate, phenytoin, penicillins, penicillin G, gramicidin D, pramoxine, pramoxine Hcl, carbamazepine, silicons, ethyl alcohol, ampicillin trihydrate, erythromycin base, phenytoin sodium extended, neomycin sulfate and adhesive tape). She had chronic pain at the time of the event and a family history of hypertension. Concomitant medications included benzonatate, salbutamol sulphate, hydrochlorothiazide, promethazine, calcitonin-salmon, sucralfate, magnesium, rosuvastatin, zaleplon, hydromorphone hydrochloride, pregabalin, carvedilol, allopurinol, clonazepam, combined L-methylfolate; methylcobalamin; N-acetylcysteine, PERI-COLACE, combined oxycodone; acetaminophen, levothyroxine sodium, multivitamins and esomeprazole magnesium. The patient has had 3 previous doses of influenza vaccine. The patient had received H1N1 influenza vaccine on 15-Dec-2009. The patient was a non-smoker (previously smoked 1/2 packs/day; timeframe 3 years; cumulative 1.5 packs/year exposure). On 15-Sep-2010 the patient received influenza vaccine in left arm. On 19-Sep-2010 the patient also received ZOSTAVAX subcutaneously. Her vital signs on 19-Sep-2010 were blood pressure (BP) 90/60, pulse rate 80, pulse rhythm regular, respirations 16 and temperature 97.9 (oral). On 23-Sep-2010 morning, the patient experienced extreme pain in left chest, under breast and radiating to near-spinal column. She was treated with lidocaine 5% ung (ointment), 'lipo-lido-lperam 10%-10%-5%' and doxepin ung. The patient was subsequently hospitalised in Nov-2010 and was treated for pneumonia and cardiac problem which was not well defined. She had an abnormal BNP and was felt to have a small vascular ischemia but a non acute myocardial infarction. On 02-Sep-2011 the patient had a follow up visit at a pulmonary specialist clinic. At that time she still had chest tightness cough and was having some difficulty removing secretions. She had exertional shortness of breath and had been using a nebuliser at home which gave her some relief and helped her to clear mucus. She has had no chest pain and no chills or fever. Her vital signs were temperature 98.10 Fahrenheit, pulse 75, respiratory rate 24, BP 132/70 and SpO2 (oxygen saturation) 94. A review of systems included positive: shortness of breath at rest, shortness of breath with activity, cough, wheezing, orthopnea and GERD (gastroesophageal reflux disease). Negatives included: fever, chills, night sweats, excessive daytime sleepiness, sinusitis, hemoptysis, chest pain, palpitations, paroxysmal nocturnal dyspnoea, edema, sore throat and syncope. On the day of the visit, the patient complained to the physician about left sided chest pain. A chest X-ray was performed with no evidence of fracture or anything that would cause the pain and was abnormal with haziness in the right base unchanged from previous x-ray. There were chronic changes present with no acute infiltrates. Methylprednisolone acetate injection 120 mg was given. The patient reported that the Cardiologists were only treating the pain issue. The physician assessed the bronchiectasis as unchanged and pneumonia as resolved. There was no acute pneumonia on chest x-ray, however chronic changes on the right side persisted and the patient was wheezing. She was coughing her (sic) great deal but clearing with very little mucus. There was some discoloration. The patient would continue albuterol 3 times daily by nebulizer and continue with current medications. The physician commented the patient had continued bronchitis following pneumonia. She would be given a brief round of fluticasone; salmeterol combination as well as increased aerosol frequency and antibiotic. The patient was scheduled a follow up in 4 months. The event outcome was not recovered.