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This is VAERS ID 839675

Case Details

VAERS ID: 839675 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Blister, Chills, Congestive cardiomyopathy, Disseminated varicella zoster vaccine virus infection, Dyspnoea, Erythema, Fatigue, Haemoglobin decreased, Hypotension, Intensive care, Leukopenia, Lymphocyte count decreased, Multiple organ dysfunction syndrome, Neutrophil count decreased, Odynophagia, Ophthalmological examination normal, Platelet count decreased, Polymerase chain reaction positive, Rash, Rash vesicular, Scab, Skin lesion, Thrombocytopenia, White blood cell count decreased
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: methotrexate; hydroxychloroquine sulfate; prednisone
Current Illness: Atrial flutter; Cardiac failure congestive; Chronic obstructive pulmonary disease; Coronary artery disease; Hypertension; Rheumatoid arthritis
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac ablation (Successful, performed 2 weeks before the onset of the rash); Chickenpox (as a child)
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA0095075131910CAN003493

Write-up: Disseminated varicella zoster vaccine virus infection; This literature marketed report has been received from the authors of an article concerning a 70-year-old male patient. His concurrent conditions included hypertension, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease and atrial flutter. He also had rheumatoid arthritis, treated with methotrexate, 2.5 mg/d (6 d per week) for 3 years, hydroxychloroquine, 200 mg/d and prednisone, 10 mg/d. In the previous month, his prednisone dosage had been tapered from 10 mg/d. He was not receiving any biologic agents. He also reported a history of chickenpox as a child, and a successful cardiac ablation. On an unknown date, the patient was vaccinated with zoster vaccine live (ZOSTAVAX II) for prophylaxis (strength, dose, route, anatomical location, lot number and expiration date were not provided). On an unknown date, he presented to the emergency department with a 2-week history of rash, which started as a localized eruption on his forehead and progressed to a vesicular rash involving his entire body. Over this same period, he noted increasing shortness of breath, tiredness, painful swallowing and chills. He did not report recent travel. On examination, the patient''s blood pressure was 110/60 mmHg, heart rate 86 beats/min and temperature 36.8?C. On examination, his cardiorespiratory and abdominal systems were initially within normal limits. Dermatologic assessment showed numerous widespread vesicles with erythematous bases across all aspects of his body. His oropharynx was erythematous, with associated lesions. Ocular examination was within normal limits. On admission, the patient''s hemoglobin concentration was 120 g/L, leukocyte count 1.7 x10^9/L, neutrophil count 1.3 x10^9/L, lymphocyte count 0.3 x10^9/L and platelet count 84 x10^9/L. During evaluating this patient, a wide differential diagnosis was considered Given the multiple vesicular and crusted lesions, disseminated varicella zoster virus (VZV) infection was identified as the most likely cause. It was then ascertained from the patient and family that he had received a live attenuated herpes zoster vaccine (zoster vaccine live (ZOSTAVAX II)) about 1 month before the onset of symptoms. With the clinical findings and vaccination history, intravenous treatment with acyclovir was started, 15 mg/kg every 8 h, and continued for the duration of the hospital stay. The patient was placed under airborne isolation. Shortly after admission, he was transferred to the intensive care unit for monitoring. Subsequently, leukopenia and thrombocytopenia developed, with evidence of progressive multiorgan failure with hypotension. Treatment with broad-spectrum antibiotics was started. The patient died on the fifth day after admission to the intensive care unit, following withdrawal of supportive measures and initiation of a palliative approach. Klebsiella spp. Was subsequently cultured from 1 of 2 blood specimens. Polymerase chain reaction testing of a lesional swab obtained at the time of initial presentation confirmed the presence of VZV on the first day after admission, and posthumous viral genotyping by the National Microbiology Laboratory confirmed the presence of the Oka (vaccine) strain. Autopsy findings included multiorgan failure from disseminated VZV infection, with pulmonary and colonic lesions and dilated cardiomyopathy. Upon internal review, the disseminated varicella VZV infection was considered to be a medically significant event. Reported Cause(s) of Death: disseminated vaccine (Oka) strain VZV; Autopsy-determined Cause(s) of Death: multiorgan failure; dilated cardiomyopathy.; disseminated VZV infection, with pulmonary and colonic lesions


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