Age: 24.0
Sex: F
Vaccine: ANTH, SMALL
Symptoms: Pruritus, Thirst, Type 1 diabetes mellitus, Urine ketone body present, Vaginal discharge
Clinical narrative: Patient was in her usual state of excellent health prior to March 2003. Patient received ANTHRAX (2) and SMALLPOX vaccine on 21 Feb 2003. She did not receive any other vaccines on that day. She denies any unusual or prolonged site reactions or systemic symptoms within 10 days following vaccine receipt. She does not recall any viral-type symptoms just prior to or on the day of vaccine receipt. On 5 Mar 2003, she sought medical evaluation for a 2-day history of vaginal discharge and pruritis and was diagnosed and treated for a vaginal yeast infection. She had a re-occurrence of these symptoms and was re-evaluated and treated again on 18 Mar 2003. In addition to above history, patient's first recall of symptom onset was around mid-March when she experienced leg cramps which were worse at night. She also was experiencing a decreased energy level; even though she was exercising regularly, she tired more easily and noted some shortness of breath after climbing a flight of stairs. She later noted polydipsia and polyuria. Just prior to diagnosis, she was drinking up to twelve 20-ounce bottles of water in one day. She was voiding every 1-2 hours. An 8 pound weight loss was noted at the time of diagnosis. She denied visual symptoms. She was not experiencing numbness and tingling in her extremities except for an isolated episode of numbness of her right hand upon awakening about 2-3 weeks prior to diagnosis. On 3 April 2003, patient sought evaluation at a medical clinic for tongue soreness for several days, as well as her leg cramps, polydipsia and fatigue. Her glucose was checked and results were 625. She was then transferred to a civilian hospital, for evaluation and treatment. While hospitalized, once daily NPH insulin was initiated, as well as two types of oral diabetes medications. Initial follow-up was in another country, and later in home country. Between May 2003 and Dec 2004, she was tried on a number of combinations of oral diabetes medications with NPH insulin. Patient separated from job in Dec 2004 with 20% disability for her "mixed type 1 and 2 diabetes". In June 2005, she was evaluated by a Certified Diabetes Educator and an Endocrinologist and her diagnosis was changed to Type 1 Diabetes. She was taken off all oral diabetes medications. She is currently receiving medical care through providers, including a Endocrinologist. Patient has never experienced ketoacidosis. She is able to recognize symptoms of hypoglycemia and has never lost consciousness secondary to hypoglycemia. She denies diabetic peripheral neuropathy, renal disease and diabetic retinopathy. Patient denies family history of Type 1 or Type 2 diabetes. She denies being overweight, and prior to diagnosis, she typically exercised 5 days per week for 40 minutes. At the time of diagnosis, she was taking a multivitamin and oral contraceptives. Patient contacted the Vaccine Healthcare Center after hearing about DOD research on a poss. relationship between anthrax vaccine and TIDM. Patient requested completion of VEARS report and a vaccine causality assessment. Causality assessment - discussion noted patient first developed symptoms of hyperglycemia in March 03 and was diagnosed with diabetes in April 03. At time of diagnosis Hgba1c was 12.2% (4.0-5.0). Not possible to definitely determine when blood glucose levels were initially elevated. Causality assessment narrative, H&P and labs already submitted on VEARS report. No hospital or ER records received. 11/3/2009 MR from Allergy clinic 10/2009 and from DM Clinic 11/04-12/04. Patient reports dx'd with DM  1/2003, 2 months post vaccination, had to be hospitalized 2003, no records received.