Age: 57.0
Sex: M
Vaccine: ANTH
Symptoms: Photophobia, Shoulder pain
Clinical narrative: This healthy 57 year old received his first anthrax vaccination on October 26, 2004 in preparation for departure overseas.  Within the previous four weeks he had also received Inactivated Polio Vaccine (IPV), Measles-Mumps-Rubella (MMR), Hepatitis A, Tetanus-Diphtheria (TD), Meningococcal (MGC), Influenza, and Pneumonia with no reported adverse events.  He reports within one hour post anthrax vaccination he felt pressure to his "entire cranium as if someone had pumped too much air in."  Simultaneously his eyes became light sensitive without nausea, vomiting, neck pain, facial droops or weakness to his extremities.  This headache was placed at a 5/10 pain scale despite use of Naprosyn 500mg.  The headache eased with rest, lying down in a quiet darkened room and not moving his head. It spontaneously resolved after 36 hours without reoccurrence.  He reports a history of seasonal sinusitis but has never had a headache like this. He denies any past history of migraines, chronic headaches, trauma, recent illnesses, fevers or family history of migraines. Approximately 12 hours after the anthrax vaccination he reports his left elbow began to ache.  His vaccination was given in the left upper arm at the clients request as he is right handed.  This ache progressed into a constant severe pain 8/10 scale.  One hour later this joint pain had progressed to his left shoulder, right shoulder and right elbow and both forearms.  The pain was sharp and stabbing with gripping, twisting and rotational movements.  This pain persisted for 10 days unrelieved with Naprosyn use.  He reports difficulty turning door knobs, lifting, carrying groceries, sweeping, or any repetitive motion task was limited due to the pain. He reports a history of cervical degenerative disc disease at C 4-5 and C 6-7 and a history of "tennis elbow" to both the right and left elbows 3-4 years ago. He denies swelling, redness, or heat to the affected joints, bruising, trauma, or physical training prior to or after his vaccination.  He denies pain to any other joint or elevation of is blood pressure (112/78).  He discussed these complaints with his primary physician two weeks ago (early December) and was offered no suggestions as the MD was unaware of any adverse events to anthrax vaccinations. As of December 21, 2004 he no longer has any headaches or right shoulder and elbow pain; however his left elbow-shoulder pain persists. He states the pain centers in the posterior elbow in his "crazy bone" and radiates to the mid-forearm anteriorly while radiating laterally up to the shoulder mid-deltoid region. He describes pain to the anterior surface mid-forearm when placing his left palm to the left shoulder with the elbow at his side.  He describes left shoulder with mid-deltoid pain when holding his extended arm sideways at a 90 degree angle.  He reports pain to all above areas when twisting or gripping motions attempted. He cannot carry a bag of groceries in the left arm due to this pain.  He denies weakness, paresthesia, change in sensation, change in skin temperature, or cervical pain. There is no paint or limitation in range of motion to his neck or left wrist or phalanges. On April 04, 2005 reported he is "still having considerable trouble (so).  My left arm is still not working correctly. I have some serious pain when lifting anything remotely heavy (5 lbs or more). I still have a lot of trouble when attempting to twist anything (doorknob) or doing anything like using outdoor tools such as clippers. I am still using Etodolac 400mg twice a day. There is no doubt is a big help. Unfortunately it seems that it covers the symptoms somewhat but does not solve the problem. Please keep in mind I am still taking oxycodone for a neck problem. It may be helpful to note that the pain I am experiencing feels like there is no lubrication on the tendons from the middle of my bicep to the middle of my forearm.  Although I was able to complete my mission overseas, this arm definately kept me from doing many things I would normally be able to do. My sense of smell is still wacky at best. There are many things other people smell that I no longer can (I.E. smelly combat boots) and other things like disinfectant seem twice as bad as they used too! It was interesting that there is a rather unpleasant smell. Unfortunately that came thru very well! Other smells such as food I cannot pick up. I had hoped this would improve with time. Unfortunately it has not.  Also I am still having trouble with short term memory. I cannot remember where I left things even for a few minutes. I really do not know if this has improved or not."  He is requesting follow up with physicians familiar with adverse events related to anthrax vaccinations.