Age: 24.0
Sex: M
Vaccine: SMALL, SMALL
Symptoms: Alanine aminotransferase increased, Arthralgia, Blood creatine phosphokinase normal, Blood thyroid stimulating hormone normal, Brain natriuretic peptide increased
Clinical narrative: This case was received on 11 May 2012 via a third party query tool search on the VAERS database, under reference number 450371. A 24-year-old male patient received the following vaccination on 06 January 2012: ACAM2000 (lot number not reported). The site was checked on 12 January 2012 with reported good take and bandage changed prior to drive home. Upon arrival home, the patient complained of being tired. The patient awoke on 13 January 2012 complaining of diffuse body stiffness and achiness stating it was hard to move (all joints/muscles ached). The patient noted bilateral axillary and cervical lymph node swelling which made it difficulty to put arms down by his sides or lift overhead. The patient called medical and was advised reactions were normal to smallpox vaccine (SPV) but to report any onset of chest pain. The patient took 500mg of naproxen with partial relief of body aches. That evening his symptoms worsened and he reported someone was standing on his chest. He complained of a sharp pulsing pain (4-5/10) to mid chest as if bruised and it hurt to breath deep. The patient took more naproxen and got into his family's whirlpool. The patient eased (3-4/10) with heat, NSAIDs and position. The severe pain (7/10) lasted about 20 minutes. The patient's symptoms continued with this on and off pattern over the next 24-48 hours until returning on 16 January 2012 when coworkers noticed him rubbing his chest (2-3/10) and was directed to medical. On 17 January 2012, the patient's EKG was normal with no ST-T changes, labs included hepatic panel normal limits (nl) with ALT 42, CBC low hemoglobin/hematocrit (h/h) 13.1/37.1, RBC 4.13 and platelets 126, differential nl with high neutrophils 29.9 and low lymph 13.4, CK panel normal (no troponin levels of LFT/chol levels documented), BNP high 274 and normal CMP, TSH and ESR. The patient's echocardiogram was done on 01 February 2012 which was normal with ejection fraction (EF) 65%. During an interview with facility on 01 February 2012, the patient continued to complain of intermittent bouts of quick, sharp, midsternal chest aches that made him catch his breath. Duration of discomfort was about 2-10 minutes every other day. The last episode was during his 01 February 2012 echocardiogram (resolved in 2 minutes). The patient was advised position was a trigger (lying flat, on left side) otherwise bouts would occur anytime or day or position. The discomfort eased by changing position and slowing breathing down. The patient was not taking any medication routinely. The patient denied any pain or restriction in activities of daily living (ADL) and runs 1.5 mils every other days and does 100 pushups and sit ups daily. The patient admitted to some chest pain when starting pushups but says this was a different pain and was more muscular in pectoris muscles by axilla. As of 08 February 2012 the patient was advised he has not had any recurrence of chest pain since taking naproxen and denied any other systemic symptoms (shortness of breath, nausea/vomiting/diarrhea (n/v/d), joint pain, et al). The patient had a follow-up appointment with primary care physician (PCP) on 24 February 2012 for a 6-8 week checkup. The patient had no current illnesses, no past medical history and took no other medications. The patient's outcome was recovered. Documents held by sender: None.