Age: 32.0
Sex: M
Vaccine: ANTH
Symptoms: Myalgia, Nausea, Vaccine positive rechallenge, Vomiting
Clinical narrative: Experienced N/V/D after anthrax vaccines 1-3 (onset within 24 hours of vaccine receipt resolution within 24-48 hours of onset). No N/V after AVA #4-6. Increased diarrhea approximately 3 months following AVA# 3 and persisted for 6 months. Diagnosed with IBS in 07/2004. See clinical summary: Chief Complaint: " I got diarrhea after my anthrax vaccines." 33 year old ADA WM who was referred to the Vaccine Healthcare Center by Deployment Health. Patient is currently TDY while undergoing medical evaluations of new complaints following IED explosion while in Iraq. History of Present Illness: Patient has received 5 anthrax vaccines (07/31/03, 08/12/03, 08/28/03, 03/13/2004 and 10/04/2004). He denies any significance or unusual local reactions at vaccination sites. Within 24 hours of receiving each anthrax vaccine, he noted the onset of general body aches, decreased appetite, and watery diarrhea(at least 3 loose stools /day) These symptoms lasted approximately 48 hours before resolving without treatment.  After first 3 anthrax vaccines, patient recalls;;s experiencing nausea and vomiting 2-3 times emesis that considered of undigested food. 'In December 2003 (approximately 3 months after his 3rd anthrax vaccine), patient began experiencing daily diarrhea-8-9 watery, dark stools/day. Because of the intensity of the duties while deployed and limited access to health care, patient did not seek medical evaluation until 03/19/2004, which was 6 days after receipt of AVA#4. (pt does not recall diarrhea worsening until after vaccine receipt)He was seen at the bas, and his stool tested negative for blood, but was told he needed to be shipped stateside for further evaluation(while waiting for his orders, pt was involved in IED explosions 04/2004) Pt had discontinued his Glucophage in 01/2004 (on his own) the diarrhea was a related side effect. After going 4 months without Glucophage he did not notice a change in the diarrhea,He had been four months without Glucophage  and still did not notice a change in his diarrhea. He had been tired on Questran, but says diarrhea was worse while taking it. His diarrhea continued until around July/august 2004, when the number of stools and frequency declined to 3-4 stools/day, 7 days a week. Around 10/2004 after starting narcotics his diarrhea resolved(he does not recall experiencing  nausea, vomiting, or an increase in diarrhea following anthrax vaccine #5 given in 10/2004) He currently reports having 1-2 bowel movements per day which are described as normal (brown, formed, no blood or mucous) about 2-3 times /week. Patients medical evaluation has included an EGD and a Colonoscopy, both reported to be normal and evaluation by a GI specialist. He does not recall submitting stool analysis. Patient reports a sensation of urgency noted, but denies any associated vomiting ( except brief nausea and vomiting following anthrax vaccines 1-3) abdominal pain, or cramping, weight loss, or blood in his stools. He had a few episodes of stringy mucus mixed with his stool.  He denies having a history of bowel disease or food intolerance with associated diarrhea. He denies any symptoms of infection prior to receiving his anthrax vaccines.