Age: 37.0
Sex: F
Vaccine: ANTH
Symptoms: Vaccine positive rechallenge
Clinical narrative: This healthy 42 year old began her Anthrax vaccinations in 1999.  She reported feeling "loopy and weird" for approximately one week following her first immunization on 11 July 1999.  She reported "loopy" as a sensation of her skeleton moving inside her and feeling her joints move but not a true ache. She reported flu-like symptoms of nausea, fatigue, fevers, and general body aches which she self treated with over the counter medications.  She reported increasing severity and duration of the flu-like symptoms, fevers and body aches with each subsequent vaccination.  After receiving anthrax #3 on 7 August 1999, she stated her overall joint pains were persisting for weeks at a time.  She believed it to be a normal response to the vaccination and her increasing age (late 30's) so she just tolerated it.  One week after the third anthrax vaccination, she began to experience terrible throbbing headaches.  She described the headache beginning as a dull ache to the top of her cranium and within 30 minutes it was as if an ice pick were going through her forehead.  She complained of photophobia and noise sensitivity.  These headaches lasted 4-6 hours requiring use of Darvocet-N-100 to dull the headache allowing her to sleep.  The headaches occurred once every two weeks for over a year and now (2004) occur approximately twice a year.  She denies past history headaches, migraines, trauma, illness or use of glasses.  She drank one cup coffee a day with no soda and occasional decaffeinated tea.  She received her fourth anthrax vaccination on 7 January 2000.  Within one week she reported increased feelings of generalized malaise, sluggishness, difficulties getting out of bed due to fatigue, feeling hot, and generalized body aches.  These symptoms have never resolved and vary day to day.  In September 2001 she saw her physician for "restriction in all activities of daily living" due to increasing pains and limitations in range of motion bilaterally to her hips, knees and neck. She stated she could walk but could no longer run due to the pain and had problems climbing stairs, lifting and using her arms.  She reported problems with a stumbling gait with difficulty maintaining her balance. Her hip pain was a 9.5/10; her knees were a 4/10 requiring the use of a cane to assist in walking for 3-4 weeks. She reported a mild ache to both shoulders and neck at an 8/10 scale.  The pain was worse if she moved her neck side to side or rotated her head. She denied any swelling to her joints, fevers, back pain, ankle or arm pain, tremors, muscular weakness or paresthesia.  She also reported a symmetrical itchy redness to the sides of each hip joint approximately the size of an orange without swelling or being hot to touch. She believed it was a rash as there was no definitive diagnosis made. Hydrocortisone creams did resolve the rash.    She also reported difficulty with her short term memory, problems concentrating and was constantly forgetting things   Her discomfort became so intense she voiced "feelings of depression" and "having no will to live" to her physician.   She was eventually diagnosed with depression, hypothyroidism, fibromyalgia and chronic fatigue syndrome (CFS) with migraine headaches and treated appropriately with resolution of her depression.  As of this interview (2004) she continues to have symptoms of CFS, fibromyalgia and an occasional headache.   She reported a family history of multiple sclerosis and an older sister with fibromyalgia after anthrax vaccinations.  Concurrently she reported a history of "irritable bowel syndrome (IBS)" since receiving the 3rd and 4th anthrax (AVA) vaccination.  Prior to receiving the 3rd shot, she had daily bowel movements "like clockwork." Approximately 2 weeks after the 3rd and 4th AVA vaccination she reported occasional nausea with a rumbling stomach less than 15 minutes after eating and severe abdominal cramps and diarrhea. This routine occurred 6-7 times a day for approximately 6 months ultimately limiting her activities due to fear of soiling her clothes or not being able to locate a bathroom. She describes the diarrhea as a watery brown tinged liquid with alternating formed and loose stool.  She self treated herself with Imodium with some relief and began to watch her diet.  She noted that any fried foods, chili, or anything with lots of oils such as vinaigrette, salads, vegetables and canola oils would trigger an attack.  She stated the IBS occurs today (2004) every three months for one to two days.   Review of available medical records from January 2002 to present show an existing diagnosis of Fibromyalgia with generalized chronic fatigue and muscle aches, hypothyroidism, and depression.  Records document difficulties in sleeping, walking with a cane and normal cognitive functions. In 2003 she had three "benign skin nevi's" destroyed with electocautery without reoccurrence.  In November 2003, she had an exacerbation of pain and fatigue secondary to increased stress at work, home, school, father being terminally ill, and six panic attacks over the last two weeks lasting one-three hours each.   In May 2004 she underwent counseling sessions secondary to a divorce and was found to be in "good physical and mental health capable of serving her country in any form that was deemed necessary".  Medical records from 1998 to 2002 have been requested.