Age: 35.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Weight decreased
Clinical narrative: Pt is a 37 year old male who received his second anthrax (AVA) and his smallpox immunization on 13 Mar 03. Within one week, he noticed an increase in his heart rate and flu like symptoms. Initially thought it was related to his smp vaccine. The flu like symptoms cleared but he continued to experience daily intermittent periods of rapid heart rate lasting 1-2 hours. He occasionally experienced pain described as a pressure like a "tired muscle feeling" in the center of his chest. He rated this pressure as a number 3 on the scale of 1-10 with 10 being worse. He reported no changes in the pain with position changes and nothing made it better or worse. He did report occasional shortness of breath. He admits to drinking 1-2 cups of coffee every morning but has been doing this for years without any problems. He stated it felt like his heart was beating fast like "I just ran a marathon." Thought it was anxiety about his upcoming deployment so he did not seek medical attention.  He deployed and continued to have daily episodes of increased heart rate. Then at the end of May, he developed diarrhea and left lower quadrant pain. He denied fever and denied other members of his team having diarrhea. He stated he drank bottled water and brushed his teeth and washed his hands with bottled water. He stated he would have ten episodes per day and denied blood. He stated he could not keep anything down for three months. These episodes eventually decreased and cleared at 6 months. Now stools are soft, no diarrhea and has a bowel movement 2-3 times daily. Prior to deployment, he had only one bowel movement daily. Stated he had a colonoscopy that showed inflammation.  He saw a doctor in June and was told that the increase heart rate was anxiety and he was placed on Xanax and Paxil. Both of which did not help. He then saw a doctor who referred him to cardiology. He saw cardiology in Oct 03 and he was diagnosed at that time with WPW. Cardiology had been following him since and patient reports that he has not improved. He now reports that his energy level is decreasing. In Jun 03 he began to notice problems initially, with both of his feet swelling and eventually lower legs. Sometimes he noted that he would see the imprint of his socks in his legs. This would occur approx 3-4 times monthly and not associated with sodium intake. He stated that he was always ok in the mornings and would note slight swelling with ambulation and resolution with rest. He reported that he would sometimes loose 5 lbs overnight.  In mid Jan of 04 he developed facial numbness on left side of face around the edge of his eye and down the side of his cheek to his lips. A neurological and infectious disease evaluation could not identify a cause. The numbness lasted 3 months then decreased to 2-3 times monthly and would last approx 30 minutes. Last episode was 2-3 wks ago. In Feb 05 he developed a prostate infection and is currently being evaluated for blood in his urine.  Was placed on Coreg 10 mg daily the last wk of May, and he reports that he continues to feel worn down and has frequent episodes of chest pain that may last all day. He describes this pain as a tightness or soreness and at times, it may be sharp and radiate through his back. When it is sharp, he says it is# 8 on pain scale.  He reports that the palpitations continue.