acute disseminated encephalomyelitis; confusion; aphasia; inability to follow commands; febrile; tachycardic; This serious case was reported in a literature article and described the occurrence of acute disseminated encephalomyelitis in a 59-year-old male patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Literature Reference:   Co-suspect products included COVID-19 VACCINE (COVID VACCINE) for prophylaxis and INFLUENZA VACCINE for prophylaxis.   Concurrent medical conditions included pre-diabetes, dyslipidemia and intubation.   On an unknown date, the patient received Shingles vaccine, COVID VACCINE and INFLUENZA VACCINE. On an unknown date, 10 days after receiving Shingles vaccine and an unknown time after receiving INFLUENZA VACCINE, the patient experienced acute disseminated encephalomyelitis (Verbatim: acute disseminated encephalomyelitis) (serious criteria hospitalization and GSK medically significant), confusion (Verbatim: confusion) (serious criteria hospitalization), aphasia (Verbatim: aphasia) (serious criteria hospitalization), apraxia (Verbatim: inability to follow commands) (serious criteria hospitalization), fever (Verbatim: febrile) and tachycardia (Verbatim: tachycardic). The patient was treated with methylprednisolone. The outcome of the acute disseminated encephalomyelitis, confusion, aphasia, apraxia, fever and tachycardia were resolved.   The reporter considered the acute disseminated encephalomyelitis, confusion, aphasia, apraxia, fever and tachycardia to be related to Shingles vaccine.     The company considered the acute disseminated encephalomyelitis, confusion, aphasia, apraxia, fever and tachycardia to be related to Shingles vaccine.   Additional Information: GSK Receipt Date: 30-Jun-2023 A 59-year-old Asian-American male with history of prediabetes and dyslipidemia presented to the emergency department for acute onset of confusion, aphasia, and inability to follow commands. Of note, patient had received vaccinations for COVID-19, influenza, and shingles all in the same encounter 10 days prior to presentation. He exhibited no focal deficits on examination however had expressive aphasia and was unable to follow commands, requiring intubation for airway protection. He was febrile to 38.4 degree and tachycardic to 120 bpm. Initial lab work including complete blood count (CBC), comprehensive metabolic panel (CMP), ethanol level, and urine drug screen were unremarkable except for elevated blood glucose of 294 mg/dL. MRI brain with and without contrast demonstrated a hyperintense T2/FLAIR signal in the bilateral temporal lobes with periventricular and deep white matter involvement. Electroencephalogram (EEG) showed diffuse slowing however was negative for epileptiform activity. Cerebrospinal fluid (CSF) revealed an elevated CSF protein at 105 mg/dL but was otherwise negative for acute process on meningitis, encephalitis, and paraneoplastic panels. Given the patient's clinical history of recent vaccination, imaging findings, and CSF studies, he was given high-dose corticosteroid therapy for post-vaccination ADEM with methylprednisolone 1000 mg intravenous (IV) daily for five days. Patient's mentation began to improve following the first dose of high dose steroids. Repeat MRI brain with and without contrast after completion of steroid course revealed complete interval resolution of the T2/FLAIR hyperintensity previously noted, and the patient had returned to his clinical baseline at the time of discharge.