Age: 37.0
Sex: M
Vaccine: ANTH
Symptoms: Arthralgia, Chest pain, Fatigue, Headache, Hypoaesthesia
Clinical narrative: Pt is a 38-year-old male who reported no problems prior to receipt of anthrax immunizations.  AVA # 1 on 08 Feb 03:he states that within 4-6 hours he developed intermittent cramping in both legs and one arm that eased after day 4. He reports that he took some Tylenol and ibuprofen with little relief. He also states that the pain also involved his joints.  Also within 4 hrs he noticed a headache with + nausea and fever 101-102. He states that the pain was in the front of his head and that he had no vision problems. The headache lasted a couple of hrs and then subsided.  Initially thought he had the flu. Then on 12 Feb he developed a different type of headache. States this one was major, a # 10 on scale of 1-10 with 10 being worse. In addition he said he saw moving, colorful and bright spots in his visual field. With this he experienced nausea but denied emesis. Never had pain like this before. States he took some Tylenol or ibuprofen and went to bed. When he woke pain had eased but he was not pain free. On 13 Feb he had a low intensity headache but felt mostly exhausted. He stated that his symptoms cleared before receipt of AVA # 2.  AVA # 2 on 22 Feb 03: again within 3-5 hrs he began to experience cramps in his legs, headaches, fever of 102, and nausea. He took Tylenol and then went to bed. Then on the 23rd he had a major headache # 10 in intensity, again with the spots in his visual field but this time it was little spots with bigger spots on the side that interfered with his vision. He stated he noticed the onset of his headache, blinked his eyes a couple of times and then he saw the moving spots.  He reported that the spots lasted 20-30 min while headache was intense. He reports that when the spots cleared he had vertigo, which he describes as the "room was tunneling around me and I could not focus". He stated that when he went to sit down he missed the table and chair. He states that when the spots cleared his headache remained, but was less intense. Headache persisted for about 4 more hours. Between the times of 24-28 Feb he had intermittent headaches in the front part of his head but nothing as bad as the intense one. He did experience muscle and joint pain and occasional nausea. After 28 Feb he states that he felt like he got over the flu for the second time. Felt better but tired.   AVA # 3 on 08 Mar 03: Pt stated he developed a major headache within 3-4 hours after receipt of AVA. He denied vision disturbances but stated that his whole body was shaking and he had a fever. He was not sure if he had chills or not. He did have nausea but no joint or muscle pain. Stated that these symptoms lasted through the night and then from 09-12 Mar he said he had intermittent light headaches with an intensity of # 5 and associated with periods of light headiness. Also during this time he had no intense headaches and no muscle or joint pain.   Then on 13 Mar he reported that he had a major headache with same visual disturbances as with AVA # 2, and when his vision started to clear he noticed a lost of feeling in his right arm for about 20 min. He stated that his headache continued without nausea or vomiting and that he also noticed some chest pain. He described the pain like that of indigestion as if someone was standing on his chest and lasted approx. one hour. He said he thought that up to this point that his symptoms were just normal side effects from the anthrax vaccine and that it would eventually clear. He said he contributed everything to just general flu like symptoms so he went to lie down.   On 14 Mar he reports that he had a slight headache and nausea throughout the day but nothing major and was doing ok until he awoke from his sleep at 0300 hrs on the 15th with chest pain that felt like indigestion. He went back to sleep and awoke at 0500 with a major headache and then at 0700 while in formation he lost feeling in his left arm and leg and then he blacked out.   The next thing he remembers is waking up in the hospital with the sensation that the room was spinning and seeing more spots. The spots this time interfered with his vision and he had difficulty in making out other objects in the room. He also noted that he had bilateral leg numbness and left arm numbness. He stated that as the felling came back he noticed cramping in his muscles and pain in his joints. He states that he was hospitalized for a total of 4 days and his vision cleared over this 4-day period and he noticed improvement in his numbness and pain over this period as well. States that when he was released on the 19 he was feeling better but had a few spots in his vision. He reports sleeping all day on the 20th and on the 21st he had a headache # 3. He had no nausea or vomiting but felt fatigued. Then on 24 March he had a # 10 headache and left arm numbness and then on the 25th nothing. On 30 Mar he stated that his arms and legs went numb, had nausea but did not recall having a headache at that time. Now notices occasional numbness with prolong sitting.   From 24 March when he was given medication for his headache and is now experiencing some headaches ranging from 2-5 per month with an intensity of # 5-7 with numbness in arms and legs. No vision changes since April 03 when he a headache with an intensity of # 9. He states that Immitrex helps to relieve his headache to a lower intensity and now lasts approx 1-4 hrs. He reported that if he does not get his Immitrex in time the headache might reach # 10 intensity.  AVA # 4 on 12 Aug 03: pt does not recall anything out of the ordinary. He stated he does not recall receiving the fourth injection. Thinks this documentation may be a mistake because he stated he would have voiced concerns if he were required to receive it again.   Patient has also reported periods of numbness involving his legs or arms and not associated with the headache or any physical activity. Denies association with certain neck movements, raising his arms or leaning on his arm. He reports approximately 8 episodes during the past 14 months. He states that the numbness is not associated with any activity and will last 30-40 minutes. He states it most commonly involves his left arm and he describes it as a feeling that the arm is waking up after falling asleep.