Initial unsolicited report received from the literature on 30-AUG-2017. This case was linked to: 2017SA163480, 2017SA165059, 2017SA165070. (same literature). The following is verbatim from the article: Since 2003, the agency has vaccinated members for smallpox. In 2008, the agency 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 at specific location. Four cases of disseminated papulovesicular lesions occurred out of 500 smallpox vaccinations given at specific location. 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 a 24-year-old male patient who was vaccinated with a dose of ACAM2000 (batch number, expiry date, dose, dose in series, site of administration were not reported) via percutaneous route on an unspecified date. The patient's medical history was significant for xerosis cutis, treated conservatively with over-the-counter moisturizers. Patient had not experienced adverse reaction in past after vaccination. As concurrent vaccinations, patient received anthrax vaccine, hepatitis B vaccine, and influenza vaccine (batch number, expiry date, dose, dose in series, route and site of administration were not reported) on an unspecified date and not reported acute illness before or within 7 days of receiving their vaccinations. No current or recent medications were reported. On an unspecified date, patient presenting 22 days after smallpox vaccination. On an unknown date, following vaccination, patient experienced sinus infection that resolved 1 week before presentation. On an unknown date, patient experienced pruritus and burning pain 4 to 5 days before presentation and Symptoms began on his hands and feet, and spread to his elbows, chest, and right-posterior side of his neck. On an unspecified date, following the vaccination, the patient's physical examination revealed multiple 3 to 7 mm papules with central umbilication and vesicles with an erythematous base located on his ears, chest, posterior neck, and elbows. The greatest prevalence was over the hands, elbows, feet, and knees bilaterally. Patient also noted were excoriations and diffuse xerosis with fissures on his hands, elbows, feet, and knees. There were no constitutional symptoms. Patient's Viral PCR of lesions was negative for orthopox virus. MC dermatology read the biopsy specimens as spongiotic vesicular dermatitis with eosinophils. Also reported as biopsy results demonstrated eosinophilic infiltration consistent with immune-mediated hypersensitivity reaction, with no evidence of direct viral invasion within the lesions. After release from hospitalization, patient had not reported further episodes or recurrences of their lesions and contacts reported development of similar lesion. Other lab data was not reported. The patient received corrective treatment with unspecified supportive treatment, with no specific therapy. On an unspecified date, the patient recovered from the events (The lesions crusted and resolved over his 10-day hospitalization). The patient was determined to be noncontagious, released from the hospital) and left with his unit. List of documents held by sender: none. Sender's Comments: The patient experienced immune-mediated hypersensitivity, spongiotic vesicular dermatitis with eosinophils, pruritus, burning pain, papule, vesicles, excoriation, serosis, skin fissures, skin lesions post vaccination with ACAM 2000. Time to onset was compatible. The patient had reported history of xerosis cutis. The events are suggestive of an alternate etiology that needs to be investigated and ruled out before assessing the causality of the case. Also, the PCR test did not reveal any orthopox infection. Additional information regarding patient's condition at the time of vaccination and allergic history should be requested. Based upon reported information the role of the vaccination appears unlikely.