Age: 30.0
Sex: F
Vaccine: ANTH
Symptoms: Swelling, Vaccine positive rechallenge
Clinical narrative: Pt is a 36-year-old who is concerned that her Graves disease may be the result of receipt of the anthrax (AVA) vaccine. She also expresses concerns about future AVA requirements. She reports a gradual decline in health from her first shot in Sep 98 that progressed throughout AVA # 6 in Mar 00. With AVA # 1 on 11 Sep 98, she developed arm swelling and a rash on her arm. She described this rash as sandpaper, looked something like a heat rash, denied hives or fluid filled lesions, and it lasted 2-3 wks. She denied swelling past her elbow and stated that the rash was localized to the area of the shot. She also noted sleep problems in that she would wake up and was unable to fall back to sleep so she would go to work. She initially thought this was due to the separation from her family and friends. She also stated that within one week following the immunization she noticed some shortness of breath.  AVA # 2 on 25 Sep 98- she developed the swelling of her arm and recurrence of the rash. This time she stated that she had some shortness of breath and developed chest pain. She thought the shortness of breath was due to the air. She reports that she had tension and an increase in her heart rate with shortness of breath. She also reported palpitations and that these symptoms worsened with time. In addition, during this time she received AVA # 3 in which she again reported the rash and swelling as with the first two vaccinations. She denied any recurrence of rash or swelling with subsequent AVA administration.  No respiratory problems noted at this time.  She reported a history of joint pain involving mostly her knees during 1998-1999 and stated that the pain worsened with each vaccine. She also had developed shin splints that involved the area from her knees to her ankles with slight swelling of her knees.  In Jan Feb 2001 she developed knee pain so severe that she could not move. She stated the pain was constant 75% of the time and that it increased with movement. She stated that she felt fine in the mornings. She stated the knee pain resolved in Jan Feb 03 after taking her thyroid medication late in 2001. However, she does report occasional days in which she would wake up with the pain. She stated that she had some thigh pain in Jan 01 but stated that she is currently pain free.  With her AVA # 4 in Mar 99 she reported problems breathing. She stated that she could not breathe and it felt like her chest was on fire. She stated she was placed on inhalers that that they helped at the time. She stated that once she started treatment for her Graves disease she noted an improvement in her shortness of breath and noticed resolution after 1-2 yrs of treatment for Graves. She stated she is no longer using her inhalers.  She received a diagnosis of Graves disease in the summer of 2001. She stated her symptoms began in 1998 during her deployment and it continued to worsen. She stated she had joint pain, felt fatigued, had dry skin, increase hair loss including her eyelashes, increase appetite, palpitations, breathing problems, anxiety, and depression. She stated she was physically active and doing well on her P.T. until Mar 00 in which she had problems with her performance.  In addition to the above, she reported that with AVA # 5 in Nov 99 and # 6 in Mar 00, she developed numbness in her face around her lip area within 15-20 min and that lasted about 30 min. She stated that her lips became a little red and swollen and she denied problems swallowing or any hives. She reported that with these last 2 shots she felt depressed for the remainder of the day just like she had been flattened.