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From the 11/19/2021 release of VAERS data:

This is VAERS ID 420445

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Case Details

VAERS ID: 420445 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2010-04-01
Onset:2010-04-01
   Days after vaccination:0
Submitted: 2011-04-06
   Days after onset:370
Entered: 2011-04-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Herpes simplex, Herpes zoster, Simplex virus test positive
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-01
   Days after onset: 244
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrocortisone
Current Illness: Leukopenia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: herpes simplex virus, Confirmed it was the oka strain
CDC Split Type: WAES1103USA03961

Write-up: Information has been received from a physician concerning a 75 year old male with "chronic leukopenia" who in April 2010, was vaccinated with a dose of ZOSTAVAX (Merck) (lot # not reported). Concomitant therapy included hydrocortisone (manufacturer unknown). In May 2010, the patient developed shingles spread to his face. In October 2010, the patient was admitted to hospital with dissemination. Acyclovir IV was given for two weeks then Acyclovir oral for 2 weeks for the treatment of the adverse event. In December 2010, the patient was admitted again to the hospital and died three weeks later. On unspecified date, lab study was performed on the ZOSTAVAX (Merck) which confirmed it was the oka strain. Additional information has been requested.


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