Age: 41.0
Sex: F
Vaccine: ANTH
Symptoms: Blood folate normal, Blood iron decreased, Differential white blood cell count normal, Fatigue, Granulocyte percentage
Clinical narrative: This 45 year old reported receipt of initial Anthrax (AVA) vaccine offered during tenure in 2002-2003 with series being held due to pregnancy. However, a medical record review shows administration of Smallpox vaccine (SPV) in Oct 2003 with no AVA or any other vaccine administration at that time (2002-2003). On 9/9/2010 she received her first AVA (Lot FAV249) and typhoid vaccine. Approximately 1 week later (about 9/16/2010) her menstrual cycle resumed but was reported to be early with prior menses 1.5 weeks ago (about 8/31/2010-note: medical records on 9/2/2010 document no menstrual cycle in 2 months,  and negative STD/pregnancy tests). Based on below YAZ timeline, her cycle was due on 9/10/2010), she described this early cycle as 5 days of heavy bright red bleeding with clots utilizing about 10 tampon (1/2 box) and pads per day that slowed to a mild-scant vaginal bleed lasting a total of 3 weeks (estimated bleeding 9/16/10-10/07/10). She did advise she told her unit but did not seek any medical care for this event. On 10/15/2010 she received AVA vaccine #2 (lot FAV249). She stated 2 days later (about day 10 after cessation of last cycle), her menstrual bleeding began again with a wax/waning like bleed similar to prior event using up to 10 tampon/pads for 2-3 days with mild-scant bleed for next 2-3 weeks. She also complained of extreme fatigue described as a "sudden urge to sleep as if she's completed a 30 minute workout" and that "hit like a ton of bricks" needing to take 2-30 minute naps per day. She advised her activities and work schedules did not change and she was unsure where she was in her YAZ cycle (estimate YAZ timeline calculates menstrual cycle was due 10/8/2010 and 11/5/2010). She further advised by mid-November her bleeding had stopped about 11/15/2010. She continued to take YAZ daily and again did not seek medical care. Over the next several months she advised her cycle became more regular on non-generic YAZ. On 5/19/2011 she received AVA #3 (lot # unknown). She reported she had just finished her menstrual cycle (to start new pack YAZ on 5/20/2011). Approximately 2 days later she reported break through menstrual bleeding that was not as intense as prior episodes that lasted 2 week. She advised bleeding had resolved by her change of status by 6/11/2011. Her only persistent complaint was fatigue (urge to nap) but stated she attributed fatigue to PTSD, anxiety attacks and personal issues (talked with health care worker on). Over the next 3 years she reported no changes to her menses and there were no complaints of fatigue reported; there were no GYN exams available until 2014. On 4/8/2014 during her annual GYN exam she requests restart of YAZ complaining of gradual onset of urinary frequency, urgency and incontinence x 6 months with "moderate vaginal bleeding that occurred in a bi-monthly pattern with no precipitating factors. She has had irregular menses while off BCP in 2013 (but not to level bleeding she had in 2010). Contraceptive historty list use of Mirena, IUD, NuvaRing, and oral contraceptives (Orthotricyclen and Seasonale) of which none provided relief of her dysmenorrhea or irregular cycles until placed on BEYAZ". On 5/20/14 she was diagnosed with ovarian cyst and fibroid.