Age: 24.0
Sex: F
Vaccine: ANTH
Symptoms: Nuclear magnetic resonance imaging brain abnormal, Nuclear magnetic resonance imaging normal, Pyrexia, Red blood cell sedimentation rate normal, Rheumatoid factor negative
Clinical narrative: Pt states that she received an anthrax vaccination in 3/1998 (date unknown/unable to locate medical record from 1997-1998). The pt states that in Mar 98 while abroad she was hospitalized for 7-10 days for a viral-like illness possibly mononucleosis with the following symptoms: severe joint pain (knees, hips, and hands), headache, fever (104.6), swollen lymph glands, diarrhea, abdominal pain and nausea. After discharge from the hospital she continued with complaints of fatigue, joint pain, GI distress (gas, bloating, cramping, diarrhea, constipation), myalgias, and increased sleep problems (unable to wake up and excessive daytime sleepiness--the pt has had problems awaking since HS--was often late to class--has continued since she entered the military-seen 7/97 and 10/97 for sleep arousal problems and issues related to work). The pt had improvement (although not resolution) of her symptoms until she received anthrax vaccinations in 2004 (2/24; 3/9; 4/9; 9/13). In Mar 2004 while abroad, the pt had severe GI symptoms (diarrhea, cramping, bloating, gas, weight loss, no N or V) and worsening of her sleep problems (diff. awakening, sleep deprivation. After 30 days the pt was transferred back. The pt started having cognitive problems ("word finding, speech problems") around Aug/Sept 2004. She also experienced left leg and left arm weakness, problems with stumbling, left shoulder and left elbow pain and intermittent left arm paralysis. By 2006 the pt states she was "much improved" although not 100%. Then the pt received anthrax vaccinations on 2Feb07 and 12Aug07. She states that in May 2007 she started to have severe left shoulder pain (injured during fall 2/07 and while abroad 5/07 bilateral foot pain in June2007, followed by irritable bladder symptoms, locking of left jaw and neck pain. In March 2008 she started to have cognitive problems (basic math skills, word finding, stuttering) which worsened after pt stumbled and hit head. Also starting in March 2008 the pt experienced left leg and arm weakness, stumbling, right sided facial weakness and right eye visual distortion. Currently, the pt continues with tendon insertion point pain (neck, jaw, shoulders, elbows, hands, hips, knees, ankles, feet), diffuse arthralgias (hips, knees, left jaw, left shoulder > right shoulder; hips/knees worse in cold weather); myalgias (across shoulders, neck, arms, legs and back), TMJ, "some weakness in left arm and left leg, neuralgias, cognitive problems, sleep problems (difficulty getting up -worse), soy/artificial sweetener sensitivities (improved with dietary management), and chronic fatigue. The pt was evaluated by rheumatology at hospital on 6/5/09 and diagnosed with fibromyalgia. A graded low-impact exercise program was recommended as well as follow-up with her PCM for consideration of a trial of either CYMBALTA or LYRICA. The pt was evaluated by neurology at hospital on 5/21/09. Memory testing showed "moderate memory dysfunction". The pt scored 42/50 on the MMX and 27/30 on the MMSE. The pt was referred to neuropsychology for further testing. Additionally, there was "notable weakness with left foot dorsiflexion, left foot eversion and inversion". The pt was referred for NCS and EMG.  8/10/09 Medical records received DOS 1/22/09 to 6/15/09. Assessment: Tendonitis, chronic pain. Patient states 'I am concerned that my multiple medical problems are related to the anthrax vaccination". States that after anthrax vaccination in 1997 she has been hospitalized for severe joint pain (knees, hips, hands), headache, fever, diarrhea, abdominal bain, and nausea. After discharge she continued with fatigue, joint pain. sleep problems, GI distress (gas, bloating, cramping, diarrhea, constipation), soy sensitivity. After anthrax vaccinations in 2004: similar severe GI symptoms including weight loss. Also had cognitive problems (finding wanted words), left leg and arm weakness, right facial weakness, left shoulder and elbow  pain, stumbling, worsening of sleep problems. After anthrax vaccinations in 2007: severe left shoulder pain, bilateral foot pain, leg numbness, cognitive problems (math skills, word finding, stuttering. Left arm and leg weakness. Blurry vision, chest pain, shortness of breath, HPV, HSV-2, galactorrhea, night sweats, hair loss, Reynaud's. Multiple chemical, environmental, and occupational hazard exposures. Patient was not examined on 1/22/09.