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In JROTC (Junior Reserve Officers' Training Corps), shoulder cords primarily signify achievement, affiliation, or rank within the program

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This is probably related to the variety of drugs implicated in triggering this adverse reaction and the interaction of elements such as genetic susceptibility, drug-metabolizing capacity, interactions with previous infections, or activation of latent viruses.12,17 More than 60 medications have been associated with DRESS.11 The most often implicated are aromatic anticonvulsants (phenytoin, carbamazepine, oxcarbazepine, phenobarbital, primidone, lamotrigine)