Received Nov 10, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| VARZOS | ZOSTER (SHINGRIX) | GLAXOSMITHKLINE BIOLOGICALS | 2 | 995d52 | IM / LA |
Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Additional Details: all this relayed to me by pharm d on 10/28/25. She states she could not fill out this form. She states patient actually came to her on or about 10/10/25 with this complaint. She states patient had a myriad of health complaints she felt was associated with her shot. I have reached out 3 times to phone number on file. I have had no return calls. Unfortunately this form will not autofill which is why she my have had issues filling it out.