Age: 40.0
Sex: M
Vaccine: ANTH, TTOX, ANTH, TD
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Paraesthesia
Clinical narrative: This healthy active 40 year-old received his 5th anthrax vaccination along with a Tetanus-Diphtheria booster to the left arm on October 17, 2004.  He reports no previous history of adverse reactions to previous anthrax vaccinations other than some initial burning with soreness and mild erythema to the immunization site.  Within twelve hours of receiving the 5th anthrax vaccination his left arm was sore and felt tight 4-5/10.  He attributed this discomfort to the physical readiness testing he had completed that morning.  He slept poorly that night due to "vivid wicked dreams" with increasing pain, aching, redness, and swelling to the left tricep region with "shooting pains and tingling extending to his pinky." He advised medical that morning (10/18/2004) of this development.  Through out the day he began to have problems concentrating and remembering why he called clients, phone numbers or what he was saying in mid-sentence.  His sister, noticed he was intermittently slurring his words and appeared to have a swollen tongue. The patient denied any difficulty swallowing or breathing. On October 19, 2004 after another poor nights sleep with increasing redness, swelling and left arm pain, diffuse muscle aches and pains, chills, multiple joint pains "everywhere", bilateral hand/finger "nervous tremors", headaches and continued memory concerns he was sent to a Acute Care Center for further care.  He states Dr. diagnosed him with a "systemic reaction to anthrax vaccination" and possible left arm cellulitis after consulting the Vaccine Healthcare Center and referred him to Infectious Disease.  MD reported a "10 cm erythematous swollen" tender left tricep with possibility of cellulitis.  Previous treatment with Motrin 800mg TID was ineffective and he was changed to Indocin.  He was given Diprolene cream, Ciprofloxin 500mg po for cellulitis, and Xanax for nervousness.   He saw Nurse Practitioner & Dr. @ Infectious Disease on October 20, 2004.  He states after a comprehensive exam, NP agreed with Dr. diagnosis and recommendation for an anthrax exemption stating a "CDC survey reported 0.2% of those receiving the anthrax vaccination have similar symptoms as his".  He was requested to follow-up with her on October 22 & 25, 2004 for re-evaluation.  He reports his headaches began on October 19, 2004 as a tight sensation to the back of his head radiating forward into his forehead centering behind both eyes.  He describes the pain as a constant, nagging, non-sharp discomfort at a 4/10 scale for the last 1½ day. Stretching his neck muscles does relieve the headache for a few seconds.  The headache is not affected by positional changes yet eases when he lays flat and worsen while upright.  Motrin does not relieve the pain.  He denies photophobia, nausea, vomiting, neck pain, recent illness, fevers, chest pain or breathing problems or weight gain/loss.  He reports feelings of lightheadedness and dizziness coinciding with the onset of his headaches as if he was disorientated or hyperventilating. He cannot state what symptom came first.   He reports his vision is normally 20/15-20/10 bilaterally but is having problems focusing on objects requiring him to look away then back in order to refocus.  He describes the focusing problem as "blurriness with difficulty reading numbers on the TV" from 10-15 feet where prior to the immunizations he could read without problems.  He denies tinnitus (ringing in ears), diplopia, halos, photophobia or seeing spots or floaters.  He states the headaches do not influence the dizziness; whereas, deep breathing does make the dizziness/lightheadedness and visual blurring worse.   Along with the headaches and dizziness, he reports coordination problems.  He has difficulty holding onto small objects, cups or reaching out and grasping them. Over the last 1-2 days, these objects seem to just fall out of his hands.  He reports he can grip but his muscles just "let go."  He reports losing his balance and feelings of instability while turning corners as if "he were clumsy" but denies any weakness.  He reports a "nervous shooting sensation" that radiated down his arms, legs and torso since Tuesday morning as if "chilled," without fevers, that results in body tremors and "jumping" fingers.  There is an associated "tingling" with increased nerve hypersensitivity but not numbness.  Stretching hard will stop these reactions but they return within a few moments.  His muscle and joint pains are a 4-5/10 scale with the worst felt in his right shoulder and neck area yesterday.  He reports history of bilateral rotator cuff tears requiring daily Motrin.  He is afraid to pursue normal exercise routines because of the dizziness, trembling, and the visual focusing problems. He has not worked for 2 days because of these symptoms.  He reports feeling better today, October 21, 2004, with the "TD soreness gone" in the left arm but the anthrax site is still sore.  He continues to sleep poorly and had three diarrheal (loose) stools yesterday (October 20, 2004). He reports a constant gnawing stomachache as if hungry.  He began the Atkins diet approximately October 14, 2004 but has not had these symptoms with past use of the diet.