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This is VAERS ID 584435

Case Details

VAERS ID: 584435 (history)  
Form: Version 1.0  
Age: 71.0  
Gender: Male  
Location: Vermont  
Vaccinated:2015-03-20
Onset:2015-03-25
   Days after vaccination:5
Submitted: 2015-07-05
   Days after onset:102
Entered: 2015-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. K023624 / 1 RA / SC

Administered by: Other       Purchased by: Military
Symptoms: Pain, Rash pruritic, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient mail orders
Current Illness: None
Preexisting Conditions: Shingles in July 2004; No known drug allergies; Heart disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on back similar to shingles rash, subsided after couple weeks, but itchiness and pain remains still today. Patient is still taking gabapentin for the pain.


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