Age: 23.0
Sex: M
Vaccine: ANTH, SMALL, TYP
Symptoms: Electrocardiogram normal, Exercise electrocardiogram normal, Exercise tolerance decreased, Feeling abnormal, Insomnia
Clinical narrative: 3/19/2017 Discharged patient called Support line with questions concerning receipt of Anthrax vaccine #1 (AVA), Smallpox vaccine (SPV), and Typhoid Vi vaccine on 9/6/2011 as potential cause for his heart issues, difficulty in running - shortness of breath and overall changes in ability to exercise, hike, etc. Since 2011 he reports being diagnosed with PVCs, tachycardia, diastolic dysfunction left ventricle and aberrant conduction and other health issues. He is challenging a denial on his health issues being unrelated to career and requests IHB to assist with causality assessment. He is also working with a representative on this issue. IHB case 7703. A comprehensive review of his medical records (see HPI) suggests the following timeline of events: On 8/22/2011 he was treated for a viral illness and treated with guaiphenesin, nasal spray and pseudoephedrine. 2 weeks later he received his first AVA, SPV, and a typhoid Vi vaccination with no unexpected sided effects. 10/8/2011 he c/o difficulty running w/SOB but no chest pain. Base on other IHB case review where athletic like individuals c/o changes in exercise capabilities include differential diagnosis of myo-pericarditis 10-30 days of receipt of SPV was considered; however he had a recent viral illness which can also result in a viral myo-pericarditis. There were no EKGs or cardiac labs at this time. His complaints of palpitations did not begin for another 21 months and suggests SPV may not be a contributing factor but it cannot be totally excluded (see below discussion). Sequential AVA vaccines on 10/24/11 and 7/20/12 did not result in any adverse reactions being reported or worsening of his exercise program or any new symptoms. He received his 4th AVA vaccine on 1/23/2013 with an HPV vaccine 1 week later on 1/30/13. About two weeks later he reported to medical with initial complaints of anxiety and difficulty sleeping (see above HPI notes). About 5/20/2013 or 120 days after his 4th AVA vaccine he reported his anxiety worsened and he experienced palpitations with shortness of breath. EKG was normal and treated for anxiety. While AVA vaccine package insert does list insomnia as a post-exposure adverse reaction; It does not list anxiety or shortness of breath. Anxiety symptoms include feelings of panic, fear, and uneasiness, problems sleeping, shortness of breath, heart palpitations, not being able to be still and calm, dry mouth, numbness or tingling in the hands or feet, nausea, muscle tension, dizziness and more. He was seen by mental health providers and given diagnosis of adjustment disorder with anxiety. His 5th AVA vaccine was administered on 7/22/2013 and 72 days later (*10/4/2013) he took 2 ALKA SELTZER PLUS as he felt bad and c/o dizziness, palpitations (see HPI note) and had to sit up to stay calm. While his EKG showed ST had slight intraventricular conduction delay and no significant abnormalities, his HCP diagnosed possible dehydration vs adverse reaction to DM component in cold medicine and not a reaction to vaccinations. EKG changes were identified in November 2013 by cardiologist. This again suggests viral insult as precipitating factor and not the AVA vaccine.