Age: 43.0
Sex: M
Vaccine: ANTH
Symptoms: Rash, Tinnitus, Vaccine positive rechallenge, Vomiting
Clinical narrative: Patient request evaluation of adverse events following  the receipt of the anthrax vaccine. He was in his usual state of good health when he received the vaccine and was taking no medication. The following is an account of the sequellae. 02/05/03: Patient received AVA#1, influenza, typhoid vi and meningococcal vaccines. No local reaction. Two days post vaccine he developed fatigue and intermittent throbbing frontal headaches with photophobia that lasted for 5 day then resolved. He took over the counter NSAIDS and did not seek medical care. 03/20/03: Received AVA #2, 24 hours later the headaches returned with the same characteristics as above. 2-3 days post vaccine he developed muscle and joint aches in the shoulder, arms, ankles, right leg and low back. He also developed a significant local reaction and " could not us my are due to weakness and pain" for 2 days. Over the counter medications were not effective. Symptoms lasted approximately 7 days then resolved. He did not seek medical care. 04/16/03: 5-6 hours after receiving AVA#3, he experienced nausea, vomiting, feverishness, diarrhea and joint aches. He again took over the counter medications, did not seek medical care and symptoms decreased but did not resolve by the time he was deployed to Iraq on 04/20/03. His symptoms exacerbated after reaching the middle east but resolved in a few days. After this he continued to have severe headaches 2 times a week that often lasted 24 hours. He describes them as starting in the back and moving to the bilateral frontal region. They are associated with photophobia and throbbing in nature. He wrote home for Excedrin Migraine and ben-gay type creams. He also continued to have intermittent joint and muscle pain in the shoulders, knees and elbows with associated fasciculations in the left arm, low back and right hand. 09/16/03: After AVA#4, symptoms continued as stated above. Also began having watery diarrhea for 5 days as did about 70 others who had the anthrax vaccine at the same time. He states he did not want to take the 4th dose and reported this to the medic. There were no physicians available to express his concerns to. He states he was 'forced' to take the 4th dose. Shortly after this shot he developed a generalized rash that was pruritic, papular, erythematous and presented in scattered circular patches 1-4 cm on his legs, arms, shoulder and chest. He did seek medical care for this rash and was given an unknown cream that he states did not help. The rash lasted 1-2 months and then resolved, only to reappear in 11/04. Again the rash lasted until 01/05. He used over the counter lamisil which did not help. 03/18/04: Following AVA#5, states symptoms described above were present at time of receiving the shot and continue until the present. He is unsure if symptoms worsened at the time of AVA #5. Not: During his tour in Iraq, from 04/20/03 through 04/20/04, he also abruptly developed bilateral tinnitus which he cites as beginning in 06/03 after mortar attacks and other loud explosion encounters. It is unknown if this symptom is also related to receipt of the anthrax vaccine. Additionally he sustained an injury to the back, knee and left wrist after an explosion and he was thrown down a flight of steps. He is pending surgery to the left wrist and hand in 04/05. During the course of medical evaluation upon returning to the US, he was evaluated by the Sleep Disorders Clinic and was diagnosed with sleep apnea. He currently uses nightly CPAP. 03/02/05 Problems related to adverse event: Insomnia NEC, Headache, Pain in joint and rash.