Age: 25.0
Sex: F
Vaccine: ANTH
Symptoms: Influenza like illness, Injection site oedema, Laboratory test abnormal, Lymphopenia, Monocytosis
Clinical narrative: 1 week after service member received anthrax vaccine (1) she developed fever up to 104, headaches, myalgias, back pain, anorexia and dizziness. History was obtained from hospital records dated 03/04 through 03/08/2003 and a telephone interview with service member on 09/27/2005. Service member has poor recall of specific details surrounding reaction  as she was acutely ill and it was over 2 years ago. 27 year old female who received her first anthrax vaccine on 02/27/2003 (Thursday). Service member received the anthrax vaccine in her left arm. She does not recall if she received the vaccine in the triceps or deltoid region, but recalls some swelling and tenderness surrounding the site, she does not recall other details pertaining to a local reaction. Approximately 1-2 days after vaccine receipt, service member developed fever, chills alternating with sweats, nausea and generalized body aches. It felt like she was coming down with the flu. After the symptoms persisted for 48 hours, she called the Immunization clinic and was told to call back in a few days if the problems persisted. When she called back in a few days as instructed, she was told over the phone that her symptoms were probably not from the vaccination. During the next two days, she continued to run a temperature up to 104 degrees and experienced nausea and had difficulty taking in fluids and food. Her symptoms continued to worsen to the point where she was dizzy, very weak, and she could not keep anything down. She reports virtually no fluid intake (when subtracting input from output) for 3-4 days and continued to run high fevers. Around post vaccination day 4 or 5, She still had generalized aches, but also developed severe joint pains which affected all her joints. She described this pain as every single joint in my body hurt like never before. She was unable to walk and was only able to do minimal activities of daily living not much of anything functional, except breath and it even hurt to do that.  She rates the joint pain intensity as a level 8 using a pain scale of 0 no pain to 10 worst pain ever experienced). She does not recall any joint redness, warmth, or significant edema. She also began experiencing some flank pain left > right side, this pain intensified with coughing and deep breaths. On 9/4/2005 she made an appointment with her primary care provided, who after consulting web sites and infectious disease physician, stated that she was very confident this was in fact a reaction from the anthrax vaccination, She was seen again on 3/6/03 at the clinic where it was noted that she was hypotensive and severely dehydrated. She was then referred to the ER. While in the ER, she received 6 liters of IV fluids and was then admitted. Her diagnoses at time of hospital discharge were, Pyelonephritis (both her primary care provider and service member feel that her dehydration contributed to the development of of pyelonephritis, serum sickness due to anthrax vaccine, and Anemia. It was later determined that this episode was line of duty and her related medical expenses were covered through the military. After she was discharged, she recalls being on bed rest for a week before returning to her usual routine. She has had no recurrence of pyelonephritis, but does typically have 1-2 UTI's per year. She was instructed by an infectious disease physician not to receive additional anthrax vaccines. her anemia was treated with iron supplements and has continued to be monitored, according to service member, it was improved without additional evaluation or treatment. Patient denies similar reactions following vaccinations or medication prior to March 2003 or since then. She does not specifically recall any rashes or cutaneous manifestations, but her hospital records note a faint rash on her abdomen. her records also mention headache, visual changes with her dizziness, passing a clot vaginally the morning after admission (1 1/2 weeks following her LMP), and one diarrhea stool on the morning of admission, but none prior. She does not specifically recall details recall details related to theses symptoms as she was acutely ill. She had no recent travel prior to her admission. She was out of the country 5 month prior). She denied any infections prior to vaccine receipt. She has no history of STD's. She says that her GU related symptoms did not occur until after she was dehydrated, she does not recall experiencing any dysuria, hematuria, or urgency. She had not initiated any new medications prior to symptom on set. Refer to Family history below.