Initial unsolicited report received from the literature on 30 Aug 2017. This case was linked with 2017SA163480, 2017SA165059, 2017SA165064_same literature. The following is verbatim from the article: ABSTRACT Since 2003, the employers has vaccinated employees for smallpox. In 2008, the employers transitioned to the second-generation vaccine ACAM2000. Cutaneous adverse events associated with this vaccine are rarely characterized. We review the medical literature on cutaneous adverse events with ACAM2000 and describe four new cases that occurred in primary vaccinees. Four cases of disseminated papulovesicular lesions occurred out of 500 smallpox vaccinations given. Each case was followed by dermatology and preventive medicine. Biopsy specimens were examined at Medical Center and the Centers for Disease Control and Prevention. Three of the cases had variable clinical history of dermatitis. Case 1 experienced the most extensive lesions and case duration, and Case 4 the least. All biopsy sample results confirmed immune-mediated hypersensitivity. This study relied on self-reporting and on surveillance by unit medical staff to identify cases. Each case also received multiple other concurrent vaccinations. Further study is needed to increase our knowledge of these cutaneous reactions and demonstrate possible associated or causal factors. This case involves 25-year-old female patient who was vaccinated with a dose of ACAM2000 (lot number, expiry date, route, dose, dose in series and site of administration not reported) on an unknown date. (The patient might have received the vaccine over a 1-week period between 29 Jan 2011 and 03 Feb 2011). No significant past medical history was reported, and the patient had no past medical history of skin disorders and the patient denied any history of xerosis cutis or dermatitis. The patient had no past history of adverse reaction after immunization. It was reported as the patient was taking self-treatment with Benadryl and Zyrtec for seasonal allergies. The patient concurrent medications were reported as ANTHRAX VACCINE, HEPATITIS B VACCINE and INFLUENZA VACCINE (Batch number, expiry date, manufacturer, dose, dose in series, route and site of administration were not reported for all the vaccines) on an unknown date, and not reported any acute illness before or within 7 days of receiving these vaccinations. On an unknown date, following the vaccination (also reported as presenting 14 days after predeployment smallpox vaccination), the patient developed cutaneous Reactions Associated with ACAM2000 Smallpox (also reported as the patient presented to the emergency department with complaints of multiple dermatological eruptions), and on an unknown date following vaccination, the patient developed a pruritic papular dermatitis approximately 4 days before presentation, and the patient Symptoms began on her right heel and progressed over the next 24 to 72 hours to involve the contralateral heel, bilateral anterior thighs, dorsum of hands, elbows, and ears. On an unknown date, following the vaccination (also reported as on presentation), the patient physical examination revealed multiple 3 to 10 mm erythematous papules, concentrated on extensor surfaces of her knees and elbows and dorsal hand surfaces and the largest lesion was on her left ear pinna. Multiple lesions were noted on her ear pinnae bilaterally, as well as her torso and anterior thighs with excoriations. The palms were spared bilaterally, and there were no vesicles. On an unknown date, the patient also developed pharyngitis, cough, sore throat, and subjective fever for approximately 24 hours beforepresentation. On an unknown date, the patient was hospitalized and discharged from the hospital on an unknown date after determined to be noncontagious. The patients other lab tests include Viral PCR was negative for orthopox virus, comprehensive metabolic panel, complete blood count, complement panel complements C3 and C4), complement CH50, qualitative human chorionic gonadotropin, immune complement C1q binding and urinalysis. The patient received unspecified supportive treatment with no specific therapy. On an unknown date, the patient recovered from all the events. (It was reported as all the symptoms were resolved except for pharyngitis, which resolved over the next 24 hours, and the lesions resolved over her 10-day hospitalization). List of documents held by sender: none. Sender's Comments: A 25 year old female patient received ACAM2000 and experienced pharyngitis with symptoms fever, sore throat, cough and skin reaction with symptoms dermatitis popular, pruritis. Erythematous rash, excoriation. Pharyngitis is unlisted while skin reaction considered as listed with vaccine. Time to onset is compatible with the role of vaccine. Viral PCR of lesions was negative for orthopox virus. More details regarding patient's medical history, immune status, allergic test result and investigation reports are needed for fully assessment. Based on the available information role of vaccine cannot be excluded.