Age: 54.0
Sex: M
Vaccine: ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF, FLUX, MEN, SMALL, YF, ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF, ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF
Symptoms: Chest pain, Myocardial infarction
Clinical narrative: From initial information received on 12/08/03 through an enhanced surveillance program conducted by the CDC (VAERS # 212869), it was reported that a 54 year old male pt received several vaccinations including a dose of Yellow Fever Vaccine (lot number, manufacturer, route and site of administration not reported) and a dose of Smallpox vaccine (lot number, manufacturer, route and site of administration not reported) on 02/15/2003.  The pt was hospitalized and diagnosed with MI on 10/03/03.  It was not reported whether the pt recovered.  No other information was provided at this time. From additional info received on 12/15/03 from CDC, a copy of the VAERS form filled out by the initial reporter was provided. The responsible physician, vaccine administered by, and initial reporter info was provided. The pt received a concurrent immunization with Yellow Fever vaccine, meningococcal vaccine, smallpox vaccine, influenza vaccine, hep B vaccine, hep A vaccine and anthrax vaccine on 2/15/03. The pt also received two separate doses of anthrax vaccine on 2/2/03 and 3/5/03 respectively. Reportedly, the pt stated that he was concerned that the vaccination he has received may have contributed to his cardiac problems. He had a history of hyperlipidemia and degenerative joint disease/osteoarthritis. The pt stated that he sometimes became short of breath after exercise, but that this was baseline for him. He recalled feeling a heartburn while resting on 10/2/03, which he described as "a strong urge to burp," but he was unable to do so. Reportedly, the pt described the sensation as a burning feeling in the middle of his chest and rated it as a six out of ten on a pain scale. The pt's medical records report that he had experienced intermittent chest pain/ pressure at rest for two to three weeks. The pt was seen in the ER where he was diagnosed with a myocardial infarction. HE had elevated cardiac enzymes, initial EKG with ST elevation in Lead III, and subsequent T-wave inversion in leads, II, III, and AVF. The pt was hospitlaized and underwent a cardiac catheterization with stent placement. Mild posterior wall hypokinesis was revealed. The left heart catheterization and left ventriculogram and coronary angiogram revealed severe two-vessel coronary artery disease with the right coronary artery being the culprit of th ept's recent non-Q myocardial infarction. The left anterior descending artery is very small caliber. Not optimal for surgical intervention. Normal left ventricular systolic function. A radiologic examination was performed on 9/22/03, which revealed the lungs to be midly hyperinflated, but clear of infiltrate. Laboratory testing was performed. Since discharged from the hospital, the pt denied any further chest pain or "heartburn" type symptoms. The impression from the cardiolite scan was abnormal myocardial perfusion studyw ith ischemia in the inferolateral wall region. The pt and was scheduled for another stress test on 11/15/03. The pt's recovery status is currently unknown. No other info was provided at this time.  Follow up on 01/12/04: "ON 02/02/03 the pt was vaccinated SC with a first dose of anthrax vaccine (Biothrax, batch # FAV073).  On 02/15/03 the pt was vaccinated IM with a first dose of hepatitis A vaccine (inactive)(Lot # 644168/0980M), a first dose given IM of hepatitis B virus vaccine rHBsAg (yeast)(batch #5377AA)(manufacturer unknown), a first dose given SC of Yellow Fever virus vaccine (Batch#UB358AA), a second dose given ID in the left arm of SP (Dryvax, batch #4020071), a first dose given SC of meningococcal ACYW polysaccharide vaccine (Menomune-a/c/y/w-135)(batch @ UB269AA), a third dose given IM of influenza virus vaccine (unspecified), and a second dose given SC in the left arm of ANA.  On 03/05/03 the pt was radiologic examination revealed the lungs to be mildy hyperinflated but clear of infiltrate.  The heart and pumonary vessels appeared to be normal size.  The impression was a non-specific hyperinflation and focal degenerative changes of the left distal clavicle of the AC joint.  On 10/02/03 the pt recalled feeling heartburn while resting which he described as "strong urge to burp", but he was unable to do so.  It was reported that the pt described the sensation as a burning feeling in the middle of his chest and rated it as a 6 out of 10 on a pain scale.  On 10/03/03 the pt was seen in the ER where he was diagnosed with a MI.  The pt's medical records noted that he had experienced intermittent chest pain/pressure at rest for two to three weeks.  He had elevated cardicac enzymes, an initial EKG with ST elevation in Lead III, and subsequent T wave inversioni in leads II, III, and AVF.  See below for reported lab results.  The pt was hospitalized and underwent a cardiac catherization with stent placement.  Mild posterior wall hypokinesis was revealed.  The left heart catherization and left ventriculogram and coronary angiogram revealed severe two-vessel coronary artry disease with the right coronary artery being the "culprit" of the pt's recent non Q myocardial infarction.  The left anterior artery was of very small caliber.  It was not optimal for surgical intervention.  There was normal left ventricular systolic function.  Gated spect images of the heart were obtained after the pt's recovery, which revealed the left ventricular ejection fraction is calculated to be 66% and wall motion is good.  The impression from the Cardiolite scan was an abnormal perfusion study with ischemia in the inferolateral wall region.  The pt was discharged from the hospital and since his discharge he was denied any further chest pain or "heartburn" type symptoms.  The pt was schedule for another stress test on 11/15/03.  His recovery status is currently unknown.  It was also noted that the pt stated that he was concnered that the vaccinations he had received may have contributed to his cardiac problems.  MI was considered to be immediately life-threatening and an other important medical event (OMIC).  No further information is available.  This is an amended report.  This is a corrected report, as amended.  Information for this case was received through an enhanced surveillance program conducted by the CDC.  The VAERS # is 212869.  The AP manufacturer control # is 2003-03322." From additional information received ojn 30/Dec/2003 from manufacturer.... it was reported that lot number 5377AA does not correspond to this manufacturer product. Lot number 0980M does not correspond to VAQTA, manufacturer's hepatitis A vaccine. No other information was provided. No additional relevant information is provided for the adverse experience. This follow-up report is not submitted to the Health Authorities. From additional information received on 20/Jan/2004, the manufacturer report ID number was provided (WAES031USA02512). No other information was provided at this time.