Age: 30.0
Sex: M
Vaccine: ANTH, TYP
Symptoms: Blood thyroid stimulating hormone decreased, Blood urea normal, Borrelia test negative, C-reactive protein normal, Carbon dioxide
Clinical narrative: 33 y/o male who received his first anthrax vaccine in his upper left arm on 29 JUL 2010. He denies any significant swelling, redness, tenderness, or itching at vaccination site, and denies any unusual or persistent systemic symptoms like chills, fatigue, headache, and muscle aches. He thinks within a week of vaccine receipt he experienced GI symptoms - nausea, vomiting, diarrhea, fever, cramping, with decreased oral intake. At the time, he assumed it was food poisoning. His symptoms lasted about 3-4 days while patient was essentially bedridden, but he did not seek medical evaluation. The symptoms did not recur. Patient also denies symptoms of a hypersensitivity reaction following vaccine receipt. No flushing, itching, dyspnea, hives, facial swelling, and itching or swelling of throat and/or tongue within the 1st 48 hours of vaccine receipt. Looking back, the onset of symptoms of itching along his jaw line and swollen glands along his jaw was within 30 days of vaccine receipt. He first experienced bilateral itching along his jaw line to his ears, which he thought was related to a rash. (He had a pruritic rash during training the previous year, so he did not seek evaluation right away). His girlfriend made a comment that she noticed him scratching his face. Then he looked closely at his skin and there were no lesions, rashes, or texture or color changes, but he did note what he describes as lumps "feeling like bubbles"; the lumps were nontender, pruritic and mobile. He denies associated symptoms like rhinorrhea, nasal blockage, sinus pressure, sore throat, headaches, or earaches. Patient reports the itching and swollen nodes have persisted for more than 2 1/2 years. He notes the itching may be worse after increased salivation, like after eating certain foods. Although the swollen glands were initially bilateral, he reports that sometimes one side is more prominent than the other. While itching and swelling are not constant, he reports experiencing them at least daily, the itching episodes usually lasting about 5 minutes. Patient describes his overall health prior to AUG 2010 as good. Since AUG 2010, he has modified his lifestyle, including decreasing alcohol intake, increasing exercise and eating healthier, which has not impacted his symptoms, but he feels more fit and has increased his PT scores. Patient was feeling fine on the day of vaccine receipt and denies symptoms of infection antecedent to or on the day of vaccine receipt. He has no known allergies (medications, foods, insect stings or seasonal allergies) and no history of asthma, eczema, or hay fever. Patient has no history of previous adverse events following immunizations (AEFI). He received two anthrax vaccines (26 JAN 2011, 20 JUL 2011), as well as FLUMIST and Tdap vaccines, subsequent to his symptom onset; he cannot recall a relationship between subsequent vaccines and symptom flares. Patient denies a previous history of swollen or itchy nodes. He denies scratches or bites around the time of symptom onset. His last trip prior to symptom onset was between Nov 2009 and March 2010. He denies environmental exposures during his service except for occupational exposure to fuels (aircraft mechanic) and tear gas exposure during training.