Age: 28.0
Sex: M
Vaccine: SMALL
Symptoms: Glycosylated haemoglobin increased, Injection site pruritus, Injection site scab, Insulin C-peptide decreased, Lymph node pain
Clinical narrative: Patient diagnosed with Type I diabetes.  He believes the illness is due to smallpox vaccine and anthrax vaccine. 31-year-old male who contacted the Vaccine Healthcare Centers (VHC) Network at the request of someone who also developed type 1 diabetes. Both service members have concerns regarding vaccinations playing a role in triggering their type 1 diabetes, as well as 3 other members who were assigned with them. The following history was obtained during a telephone interview with patient on 1/24/06 and from his narrative summary for his Medical Board. Patient received his primary smallpox vaccine on 2/26/03. He received 15 jabs in his left arm. He recalls normal progression of the smallpox vaccine site, and thinks the scab fell off around 3 weeks post-vaccine. Service member experienced pruritis at the smallpox vaccine site, but did not require antihistamines or antipruritics. He experienced fever and body aches which lasted about 12 days. He also experienced enlarged, tender lymph nodes in his left axilla and cervical nodes which lasted about a month. He does not recall any other significant persistent systemic symptoms within the first 30 days following receipt of his smallpox. Service member was in his usual state of excellent health until July 2003. Looking back, the first symptoms that the service member can recall are polydipsia and polyuria which began around the end of July 2003. He specifically recalls driving home and drinking "2-3 times as much as normal". At the time, he didn't know what to attribute his thirst to. He recalls stopping to void 6-9 times during that 9 hour drive. He attributed this to his increased fluid intake. Around August 10th, he noted a decrease in his energy level. At that time, he rates his energy level as 40% using a scale of 0 (=no energy/bedridden) to 100 (=baseline energy level). He was flying and his flights were about 14-18 hours long. He would usually stay awake the entire flight. With this particular flight, he could not stay awake even though he had slept well the night before. At the time, he knew something was wrong with him, but didn't know what. Between his initial symptoms onset and his initial evaluation in late August, patient began to lose weight, but it was not really noticeable. His baseline weight was around 170-175 pounds. By August 2003, his mother commented on a noticeable weight loss. (Since his diagnosis and treatment of diabetes, service member has gradually regained weight and now weighs about 185 pounds.) He did not experience any visual blurring or paraesthesias. In late August 2003, patient sought evaluation with the doctor for persistent and worsening symptoms. When he returned to the clinic the following day for lab work, the results were consistent with diabetes with a blood glucose level >200 and positive ketones. He was initially diagnosed as having Type 2 diabetes and an oral agent was initiated. After additional evaluation, he was started on a split mixed insulin regimen. When additional lab results supported the diagnosis of Type 1 diabetes, the oral medication was discontinued. Since then, patient has followed up with an Endocrinologist and he is currently on continuous subcutaneous insulin infusion. Patient has no family history of Type 1 diabetes. He denies symptoms of viral or bacterial infections prior to symptom onset. (He does report during his last trip abroad around 10 August, he did have one emesis after his evening meal; he had no other GI-related or other viral-type symptoms and he was not aware of any others experiencing GI-related symptoms.)