Age: 36.0
Sex: F
Vaccine: ANTH, TDAP
Symptoms: Blood thyroid stimulating hormone normal, Borrelia test negative, C-reactive protein normal, Cognitive disorder, Computerised tomogram head normal
Clinical narrative: Received first anthrax vaccine in her upper left arm on 11 OCT 2007. She also received Tdap vaccine in her right upper arm on the same day. She denies any significant reaction at or near the vaccinations sites. Patient's husband noted that she was extremely irritable within a few days of getting these vaccines, and patient recalls being especially "sleepy". At the time, if she had the opportunity, she felt like she could have slept 16 hours, but usually she had to settle for taking naps whenever she could and trying to get at least 8 hours of sleep/night. As time went on, she was sleeping through most of her weekends and every chance she would get, she would sleep. She had to push herself to complete her work as she felt very fatigued. Within days of vaccine receipt on 11 OCT 2007, patient experienced dizziness, especially with movement or when lying on her left side. She would need to use the wall to help her keep her balance when walking. This sensation was often associated with nausea. According to her spouse, she held onto the wall "constantly for almost a month". He drove, because he did not feel it was safe for her to drive. At the time, she denied that she was having a problem, but her spouse recalls her boss made her stay home for a few days because she was confused and dizzy, and her patients had commented about her holding on to the wall. Around the same time (mid-OCT 2007), patient began experiencing headaches which were noted when she tried to focus her eyes while awake, and later on (late-NOV 2007), she began waking up with headaches almost daily. Most of these headaches were accompanied by photophobia. Patient had terrible headaches when she was young, but as an adult, she previously had only experienced headaches about 1-2 times per month, and these headaches were usually relieved with an OTC medication. Patient's spouse reports patient's headaches were "terrible". Right after making dinner, she would go to bed due to headaches and nausea. Patient also noted after 11 OCT 2007, problem solving took more time and thinking took much more effort. She describes her cognitive changes as a "mental fog". She was also more forgetful than usual and really had to concentrate to follow conversations. She felt like her mental capabilities continued to decline through NOV and DEC 2007, before starting to gradually improve again early in 2008. With regard to cognitive difficulties, patient's spouse reports that patient was uncharacteristically irritable and often seemed confused. He reminded her of things repeatedly, only to have her still forget. In addition to minor things, spouse reports patient forgot to pick up her car from the mechanic one time, and forgot a meeting at their daughter's school. He also noted she had difficulty recalling words, often substituting with other words that were less appropriate. He also reports she struggled to do math in her head. Patient's spouse would ask what was wrong and she became irritated and said everything was "fine". When he tried to bring her confusion to her attention, she seemed not to be aware of it but became defensive. All of the above symptoms started shortly after receipt of Anthrax and Tdap vaccines in OCT 2007. She had never experienced any previous vaccine adverse events. Patient initially attributed her symptoms to overworking and not getting enough sleep. In late NOV (on 23 and 24 NOV 2007), patient experienced 2 minor "bumps" to the right side of her head. Although the symptoms preceded the trauma to her head, because of some confusion and not wanting to believe the symptoms were related to vaccine receipt, she did not mention this to the Neurologist or other providers. Her spouse reports that patient became "angry" when he noted a relationship between her symptoms and the receipt of the vaccine.