Age: 33.0
Sex: F
Vaccine: ANTH, MEN, SMALL
Symptoms: Injection site mass, Injection site swelling, Joint stiffness, Menorrhagia, Nausea
Clinical narrative: Pt is a 34-year-old female who developed multiple medical problems during the past year and feels that it is a result of the anthrax (AVA) immunizations that she had received. She reported the following problems: AVA # 1 on 7 Nov 99: she developed a knot and some swelling to the vaccination site that persisted for a couple of weeks. She also reported body aches and a fever that was bad for the first 3-4 days that then became "tolerable" for 3 wks. She said she took 2-3 days off work and denied any medical attention. She also stated that symptoms would clear before subsequent vaccinations.   AVA #2 on 9 Jan 00: She reported same symptoms as above. AVA #3 on 19 Feb 03: As above. AVA #4 on 30 Jul 03: As Above.  She stated that she had no problems with her endometriosis until she was in the desert. While in the desert she developed new symptoms that were different from her previous episodes. She now described severe bleeding during the first 24 hrs of her menses associated with clots, foul odor and severe pain in her back, pelvic area and body aches. She stated that she would bleed for 3 days, then it would stop for 24 hrs and then return with excessive bleeding that would last for 24 hrs. She said that this cycle would repeat itself every 2 wks. She said that she went to the medic twice and each time she was told it was stress and did not have a pelvic exam performed. She stated that the bleeding continued from May 2003 until her surgery in May 2004. She reported that since her surgery, her endometriosis has not been bothering her. During her surgery in May 04 an ovarian cyst was discovered.   On 23 Jun 04 a second surgery was required to evacuate a large blood clot between her uterus and rectum. She stated that the clot was the size of a melon and that the clot was there since her surgery in May. Also during this second surgery it was discovered that part of her rectum and bowel was attached to her uterus, peritonitis was developing and there was some remaining endometriosis outside of her uterus. She stated that there was another cyst on her ovary that was the size of a grapefruit that was drained and biopsied with a negative biopsy. She was treated with antibiotics for her peritonitis and developed the third ovarian cyst.   Patient now reports bowel problems since her first surgery in May that persists today. She stated that she is requiring medication for her bowel movements and has episodes of bloody diarrhea with intermittent constipation. She said that the blood is throughout her stool and noticed this since 04 Aug 04.  On 09 Jul 04 she began to notice joint pain throughout her entire body involving all of her joints. Pain is increased in the morning, associated with stiffness and will ease during the day. She reports that it is difficult to get up and sit down and also reports periods of stiffness with inactivity. She is taking Vioxx and the Duragesic patch and reports no relief. She stated that she had some relief with the steroid pack and that one-week after the pack was finished her pain would return.  She was evaluated by Rheumatology in Aug of this year when she was hospitalized for her pain, nausea and vomiting. She stated that her muscles are fine with occasional aches. She stated she was diagnosed with fibromylagia and that some of her blood test was showing RA.  She reports that she has had fevers since May 04. Stated that her temperature at times reaches 101 and that they still persist today. She stated that she feel hot all over to touch but that she experiences chills and her joints would ache.   She reported that she is usually very healthy and that since June she has had 3 upper respiratory tract infections. She states she is a non smoker.