Age: 25.0
Sex: M
Vaccine: ANTH, FLUN3, SMALL, ANTH, FLUN3, SMALL
Symptoms: Echocardiogram, Electrocardiogram abnormal, Myocarditis, Nuclear magnetic resonance imaging, Troponin I increased
Clinical narrative: This case was received on 14 February 2011 via a third party query tool search on the VAERS database, under reference number (VAERS ID# 413564). A 25-year-old male patient received the following vaccinations on 13 December 2010: ACAM2000 (lot number VV04003A), FLUMIST 10-11 (lot number 501045P), BIOTHRAX (lot number FAV263). On 22 December 2010, 9 days post vaccination the patient experienced chest pain radiating to the back and shortness of breath. The patient was evaluated in the emergency department and had a prolonged hospitalization. Lab data revealed myocarditis secondary to smallpox vaccination. Concomitant medications were not reported. Current illnesses were reported as none. No further information was provided at the time of the report. The patient's outcome was reported as recovered. Follow-up information was received on 27 May 2011 from MILVAX under reference number 413564. The patient had no family history of cardiac risk factors and the patient was not a smoker. On day 9 post vaccination, the patient presented with severe sub-sternal chest pain radiation, palpitations, dyspnea and fever. The pain increased with exertion and the pain improved with lying down. He was transferred to the Emergency Room (ER) to rule out smallpox myocarditis. The patient had an electrocardiogram (ECG) which showed left ventricular hypertrophy (LVH) and normal sinus rhythm (NSR). The patient's echocardiogram (ECHO) showed left ventricle systolic and diastolic functional normal, left ventricle ejection fraction (EF) 60%, no left ventricle wall or motion abnormalities, no pericardial effusion and pulmonary artery systolic pressures normal. His laboratory findings included a troponin 0.08 (H), C-reactive protein (CRP) 4.27 and a D-Dimer mildly elevated. A diagnosis of myocarditis secondary to smallpox vaccine was made. His chest pain resolved during his inpatient course, however some fatigue remained. On day 16 post vaccination, the patient had a computed tomography (CT) of the chest/pulmonary angiogram which was negative. The cardiac and great vessels were normal. The lung and pleural spaces were clear. There was no enlarged mediastinal, hilar or thoracic lymph nodes that were apparent. The upper abdomen images showed no abnormalities. On day 29 post vaccination, another ECHO was performed with the following results: cavity size normal, wall thickness and motion were normal, systolic function was normal, EF 55-60%, pulmonary arteries systolic pressure was within normal range (sub-optimal jet) and no pericardial effusion. The mitral valve showed trivial regurgitation, minimal blowing mitral valve was not diagnostic of prolapsed, and was structurally normal. The pulmonic valve velocity was within normal limits (WNL), no stenosis, trivial regurgitation, tricuspid valve structure and velocity WNL and trivial regurgitation. The patient's cardiac magnetic resonance imaging (MRI) was normal. The clinical status was reported as myocarditis secondary to smallpox vaccination. The outcome was reported as recovered. Documents held by sender: none.