Age: 21.0
Sex: M
Vaccine: ANTH
Symptoms: Headache, Injection site pain, Injection site swelling, Laboratory test abnormal, Palpitations
Clinical narrative: History of recurrent pericarditis since 2001. Awaiting complete medical records; noted from 2002-2003 show approximately 6 episodes of pericarditis and at least 1 episode of pleural effusion. Patient was healthy prior to 2001. After receiving his anthrax vaccines, patient does not recall experiencing significant local or systemic symptoms. He does recall a moderate amount of swelling and tenderness surrounding vaccine sites, and on at least one occasion, he experienced some bruising at the vaccine site. The vaccine sites remained tender for about a week. Prior to November 2001, patient was in his usual good state of health. In November 2001, while stationed overseas, patient recalls being at work and couldn't breathe...heart was racing...felt like it was going to pound out of my chest. He sought medical evaluation where a chest x-ray and ECG were done and he was diagnosed with pericarditis. He was prescribed Motrin and then released. He took the Motrin for 3-4 days and the chest pain had completely resolved by 1 week after treatment. He experienced a second episode of chest pain after returning home. Patient is not sure of the details, but believes it was around September 2002. The third episode was in early January 2003. He began noting the bottom of my ribs were sore...my heart started racing again so on the following day he went to the clinic. This time his ECG was normal and he was released. The next day the pain became worse and he began experiencing shortness of breath. He was given NSAIDS and a 2 week profile for light duty and no PT. He was seen by internal medicine on 1/27/03 and it was felt that the previous recurrent pericarditis episodes were secondary to partial treatment and he was treated with a 2 week course of Indocin 25mg TID and a continued profile for 2 months. He was asymptomatic between February and July 2003. A note from the cardiology clinic on 3/24/03 noted that patient was exercising at his own pace without problems and that there were no subjective findings or findings on physical exam or ECG suggesting recurrence of pericarditis. The next episode was in late August 2003, when he experienced chest pain (not relieved with NSAIDS or Lortab) and shortness of breath. Patient sought evaluation at the emergency room. He was then admitted for pericarditis. He had a fever of 104 with this episode. He was again treated with Indocin and Cardiology recommended no PT for 6 months. His next admission was in October 2003 with a diagnosis of recurrent pericarditis, which required pericardiocentesis. His echo showed a moderate pericardial effusion and his ECGs were reported to have ST elevations. He was discharged after about 5-7 days, and then readmitted within 10 days of discharge. His present symptoms included sharp anterior chest pain, shortness of breath, and a nonproductive cough. That admission included the diagnosis of recurrent pericarditis and bilateral pleural effusions. He was treated with Indocin and Colchicine. Patient has had no recurrence of symptoms in over 1 year. He describes the chest pain as usually being left-sided and usually a stabbing type pain. The pain intensity was usually a level 10 on a pain scale of 0-10. He noted that the chest pain was worse when laying down, and decreased when leaning forward or when walking. When chest pain and shortness of breath were at their worst, he had to sleep sitting up. He usually experienced shortness of breath and the sensation of his heart beating hard and fast with minimal activity. He also experienced headaches with some episodes of chest pain, but headaches have never persisted. He denies any peripheral edema or irregular heart rates. Prior to 2001, patient denies any previous episodes of chest pain, shortness of breath, or heart disease. He denies any symptoms of infection prior to initial episode of pericarditis. He has undergone cardiology evaluation and care since 2002.