Age: 25.0
Sex: M
Vaccine: SMALL, ANTH, SMALL, TYP
Symptoms: Troponin I increased
Clinical narrative: This case was received on 12 October 2010 via a QScan search on the VAERS database, under reference number 396136. A 25-year-old male patient received the following vaccination on 04 June 2010: a percutaneous right arm ACAM2000 (lot number VV04003A). The patient had no medical history and no current illness at the time of vaccination. The patient was seen in consultation for myocarditis in temporal association to smallpox vaccine (SPV). The patient received his primary SPV on 04 June 2010 in his right upper arm (patient was left handed). He was in his normal state of good health at the time. On 09 June 2010, the patient experienced 20-30 minutes of substernal chest pain (rated at 5 out of 10 on pain scale) which he described as a squeezing pain which worsened with deep inspiration and improved with leaning forward. The chest pain was accompanied by dizziness, shortness of breath (SOB) and diaphoresis. The patient denied radiation of the pain, nausea or vomiting. On 11 June 2010 the patient experienced substernal and left sided chest pain (rated 4 out of 10 on pain scale) described as squeezing pressure. The patient took 400 milligrams (mg) of MOTRIN immediately and the pain resolved in about 45 minutes. The patient denied SOB, dizziness, diaphoresis, nausea or vomiting. On 12 June 2010, the patient noted 5 inches of redness around the vaccination site, right axilla pain and swollen lymph nodes in the right axilla. On 13 June 2010, the patient felt fatigued and he had an episode of chest pressure (3 out of 10 on pain scale) across his upper chest (bilateral) with SOB. He took an MOTRIN with improvement of his symptoms to 1 out of 10 on pain scale. Later in the evening he had a "burning" sensation in his chest. The patient took 400 mg MOTRIN without relief. The pain was not improving with position change. After about 2 hours the "burning" increased and at that time the patient experienced SOB, diaphoresis and dizziness (no nausea or vomiting). The patient decided to go to the Emergency Room (ER). His electrocardiogram (EKG) showed ST elevations in leads, I, II, and VL; cardiac enzymes were elevated (myoglobin 116 (0-98), CKMB 7.0 (0-4.0), Troponin I 12.0 (0.0-3). He was subsequently admitted to the hospital. A cardiac catheterization showed cardiomyopathy, mild to moderate left ventricular (LV) dysfunction and normal coronaries. A transthoracic echocardiogram (TTE) showed wall motion abnormalities, mild global hypkinesis, and a left ventricular ejection fraction (LVEF) OF 45-50%. His troponin I was showed an elevation of 6.77 on 14 June 2010 and on was still elevated at 8.23 on 15 June 2010. The spiral chest computed tomography (CT) was normal. His erythrocyte sedimentation rate (ESR) of 10 and D-Dimer of 178 were normal. The patient was discharged on 15 June 1010 on Ramipril 5 mg every night (qhs), ASA 81 mg daily (qd) and CLINORIL 200 mg twice daily (bid). At that time he had constant 2 out 3 on pain scale chest pressure and frequent SOB, both of which increased with activity. (Of note: the narrative received was incomplete). The outcome was reported as recovered. There may be a discrepancy between the event date field and the onset information in the face text narrative field in the data reported Latency has been calculated using the event date. Documents held by sender: None.