Age: 28.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Electrocardiogram abnormal, Exercise test normal, Headache, Intensive care, International normalised ratio normal
Clinical narrative: This case was received on 27 November 2008 via a QScan search on the VAERS database, under reference number 310354. A 28-year-old male patient received the following vaccinations on 03 April 2008: an intradermal injection of ACAM2000 (lot number not reported) and Anthrax (manufacturer unknown, lot number not reported). On an unspecified date, the patient woke up with substernal chest pain (aching-type pain) rated as 5/10 on pain scale. The pain was not positional and it did not change with deep breaths. There were no accompanying symptoms; no radiation, but the patient did note an aching pain in his left forearm and biceps; no tingling of left upper extremity. The patient took one ASA 325 mg and then chewed a second ASA prior to going to the ER. By the time he arrived at the ER, the pain was almost gone. He was evaluated in the ER, admitted to hospital and then transferred to a medical center. On 09 May 2008, the patient had sub-sternal chest pain. A review was done of hospital medical records of 15 April 2008 and ER records of 13 April 2008. The final diagnosis was inferior wall abnormality, rule out inferior wall myocardial infarction. The records revealed that the patient experienced, on 13 April 2008, a headache, nausea, fever/chills, night sweats, decreased appetite, myalgia, sore throat. He was seen in the ER and diagnosed with a viral syndrome. He was discharged home. He later returned to the ER on 15 April 2008 with substernal chest pain that awakened him from sleep and he had left arm throbbing for approximately 45 minutes, which then spontaneously resolved. The final diagnosis was myocarditis. The patient had self administered ASA and went to the ER. A cardiology consult was done in the ER and the patient was admitted to ICU then transferred to higher level of care. The patient had an ECG and initial ECHO on 16 April 2008. The ECHO revealed an essentially normal study. Mild concentric LVH. LVSF was normal. No pericardial effusion. EF 65%. Lab data on 16 April 2008 revealed Troponin I 3.97. The patient's outcome was not reported. Follow-up information was received on 27 May 2011 from MILVAX. The patient had a history of a recent illness including a sore throat, fever, chills, decreased appetite and night sweats which were treated with TYLENOL, SUDAFED and BENADRYL. The symptoms completely resolved 5 days post vaccination. The sub-sternal chest pain also been reported to be 7/10 on a pain scale. A physical exam noted cardiovascular episodes of borderline tachycardia from 80s to low 100s. Laboratory findings on 15 April 2008 included: PT 13.9; PTT 31.0; INR 1.08; WBC; 9.1; Troponins 5.72->5.71 (H); CK 206 (H); CK-MB 14.8 (H); Percent CKMB 7.2 (H); ESR 26 (H). On 19 May 2008 laboratory findings were Troponins 3.72 (H); CK 158; CK-MB 9.9 (H); Percent CKMB 6.3 (H). Diagnostic tests 12 day post vaccination included an ECHO: L ventricular systolic function normal; L ventricular wall thickness normal; EF = 60-65%; no pericardial effusions; trace regurgitation at mitral, tricuspid and pulmonic valves; regional wall abnormalities; moderate to severe apical wall hypo-kinesis. Diagnostic test 13 days post vaccination included an ECHO essentially a normal study; mild concentric L ventricular hypertrophy; ventricular systolic function was normal; no pericardial effusion. Diagnostic tests 42 days post vaccination included an exercise stress test which reached 100% MPHR with no symptoms or ectopy, baseline non-specific t-wave abnormalities, which normalized with exertion and returned to baseline in recovery, overall impression non diagnostic and an ECG: NSR sinus arrhythmia and non-specific T-wave abnormalities. Cardiology diagnosed patient with myocarditis. Current ischemic work up was incomplete as the patient did not have a cath done during hospitalization and the exercise stress test was equivocal. Eighty-eight days post vaccination cardiology notes report the patient had a short lived and self limited symptoms associated with "+Troponin" and wall motion abnormality. This is questionably related to the smallpox vaccine. The patient had a nuclear medicine stress test that showed no evidence of ischemia with good exercise tolerance. The patient was fit for full duty and no additional evaluation or treatment was indicated at the time. Documents held by sender: none.