Age: 31.0
Sex: M
Vaccine: SMALL, TYP
Symptoms: Asthenia, Blood creatine phosphokinase, Blood creatine phosphokinase MB, C-reactive protein, Chest discomfort
Clinical narrative: Patient received Smallpox (1) and Typhoid vaccines on 2 May 2013. He received his typhoid vaccine in his right arm and denies any significant or unusual redness, tenderness or swelling surrounding anthrax vaccine site. Patient received his primary smallpox vaccine in his left arm (15 jabs) and reports normal site progression, without significant redness, swelling, warmth, or streaking. He denies pain or swelling of his axillary lymph nodes. His smallpox vaccination site was assessed as a "take". Around 5 MAY, post-vaccine day (PVD) 3, patient experienced significant fatigue. That evening he felt like he was really "dragging" and did not feel energetic. He also felt like he was running a low grade fever. These symptoms lasted about 3 days before resolving. Around 7 MAY(Post-Vaccination Day 5), patient noted usually left sided chest pain, described as soreness or like a muscle after working out. He said he felt like it would feel better if he could massage it, but the pain was under his rib cage. He rates pain intensity as 2-3/10 using a pain scale of 0(= no pain) to 10 (= worst pain ever experienced). There was no radiation of the discomfort. The pain was intermittent with each episode lasting from 10-40 minutes each episode. He denies any accompanying symptoms - specifically, no palpitations, dyspnea, diaphoresis, syncope, nausea, and pedal edema. He was aware of a "pronounced heart beat" that "just wasn't normal". The onset of his chest discomfort was usually while sitting at computer, driving, or watching TV. He noted the episodes seemed to occur during the evenings. (The second night, he had a difficult time going to sleep because of an episode.) He did not note a change in pain with deep breaths, lying, sitting, or exercise. The episodes improved after about 5 days. Patient did not self-treat except for self limiting his exercise last week. This week, they seem to have resolved. He has been able to perform his duties since vaccine receipt. Patient was evaluated on 16 MAY (PVD 14). By then, he reported the episodes were improving and he did not even notice them unless he was "paying attention". His PE was normal, including no lymphadenopathy, normal lung and CV exam. He had an ECG completed during the evaluation, which was reported as normal. He also had lab work completed on 17 MAY, including Tropinin, CK-MB, CK, ESR, and u/s CRP. He was referred to a civilian Cardiologist, who provided patient with paperwork stating: Diagnosis: "Normal Cardiovascular System." Medications: "None." Treatment Plan: "Not Needed." Patient had an echocardiogram whose results will be sent when available to his local providers. At the time of phone interview, patient reported he felt well except for "still a little sluggish". Patient describes his overall health prior to MAY 2013 as very good. He was feeling fine on the day of vaccine receipt and denies symptoms of infection at time of vaccine receipt or antecedent infections in the prior month. Patient has no history of previous adverse events following immunizations (AEFI). CVRFs: No hx DM and elevated lipids. Reports history of pre-hypertension, but not treated with antihypertensive and BPs usual run in 130's/80s. No primary family Hx of premature CAD. No tobacco use. Not sedentary. Nonobese (BMI 23.75). No hx of previous chest pain. No hx of myo- or pericarditis, heart failure, valvular disease, PVD, thrombus or arrhythmias. No hx of GI or pulmonray disease. No family hx of drowning, seizures, MVA and sudden death.