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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC.||- / UNK||- / -|
Administered by: Unknown Purchased by: ??
Symptoms: Blister, Chills, Dyspnoea, Erythema, Fatigue, Haemoglobin decreased, Hypotension, Intensive care, Leukopenia, Lymphocyte count decreased, Neutrophil count decreased, Odynophagia, Platelet count decreased, Rash, Rash vesicular, Scab, Skin lesion, Thrombocytopenia, White blood cell count decreased, Autopsy, Congestive cardiomyopathy, Ophthalmological examination normal, Polymerase chain reaction positive, Disseminated varicella zoster vaccine virus infection, Multiple organ dysfunction syndrome
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:
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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