Age: 21.0
Sex: M
Vaccine: ANTH, SMALL, TYP, ANTH, SMALL, TYP, ANTH, SMALL, TYP
Symptoms: Ejection fraction normal, Electrocardiogram ST segment depression, Electrocardiogram abnormal, Enterovirus test negative, Epstein-Barr virus antibody negative
Clinical narrative: This case was received on 15 April 2014 via a third party query tool search on the VAERS database, under reference 519294. A 21 year old male patient, with no medical history and no illness at time of vaccination, received the following vaccinations on 13 November 2013: smallpox vaccine, live (lot number VV04003A), intramuscular TYPHIM VI (lot number H1482), and BIOTHRAX (Emergent, lot number FAV328A). In addition, he had received an intramuscular injection of influenza vaccine (007011A, Novartis) on 06 November 2013. He denied any adverse reactions to these vaccinations, and medical records documented "a major take" at his smallpox vaccine site. On 30 December 2013, i.e. 48 days post-vaccination, he began to complain of stomach ache with nausea, vomiting, and diarrhea (brown-clear liquid) that night. By 6 am 31 December 2013 his vomiting had stopped and his diarrhea ceased on 01 January 2014. He denied fever, sweats, or eating any new foods, seafood, and family was not ill (ate similar food at home). He awoke on 02 January 2014 with a burning 8/10 pressure to mid chest and could feel his heart beating, his jaw was tight as if he'd just chewed or clenched teeth, and had tingling pain to left (greater than right) shoulder. He vomited once and had dry heaves. He stated it hurt to breathe deeply but reported no shortness of breath. Position changes did not affect his pain. He drove himself to nearby facility and was referred to a nearby hospital. At the emergency room his EKG showed normal sinus rhythm with 1mm ST depression V4-5, normal chest x-ray, and elevated cardiac enzymes: CK 391 (H), CKMB 13.5 (H), CK% 3.4, Troponin POC 0.56, Troponin T 0.19, normal BMP (basic metabolic panel), CBC (complete blood count), PT (prothrombin time) and INR (international normalization ratio). His pain was treated with ASA (acetylsalicylic acid), 1 liter normal saline bolus and one NORCO 5/325 with pain easing to 2/10 (like a sore muscle in his chest). He was transferred and admitted. That evening about 7pm his pain again worsened to 8/10 as dull intense chest pain without nausea or radiating pain. His EKG remained in normal sinus rhythm and he was treated with MOTRIN and colchicine with minimal relief of pain. One PERCOCET resolved his pain (0/10). He was started on routine intravenous then oral NSAIDS (non-steroidal anti-inflammatory drugs) with no reoccurrence of pain as of 07 January 2014. Laboratory data revealed the following: 03 January 2014: viral studies: HHV6 (Human Herpes Virus 6) IgG 1:160, Coxsackie B3, B5 1:8, influenza A/B AB 1:16: EBV (Epstein Barr Virus) IgG was positive with IgM negative suggestive of a past infection; and negative for parvovirus, coxsackie A, enterovirus, CMV (cytomegalovirus), RSV (respiratory syncytial virus), Lyme, Adenovirus; HHV6 DNA and Hepatitis B panel (positive Hepatitis B surface antibody). Routine laboratory studies: normal CBC (complete blood count), chemistry, PT/INR, UA (urinalysis), magnesium, phosphorus, lipid panel. Cardiac enzymes: 02 January 2014: CK 693; CKMB 30.80; CK% 4.4, Troponin I 9.690, ESR 2; CRP 24.0; CMP/LFT normal; 03 January 2014: CK 614; CKMB 25.20, CK% 4.1, Troponin I 6.880; normal lipid panel; 04 January 2014: CK 304, CKMB 6.40, CK% 2.1, Troponin I 4.600; 05 January 2014: CK 216, CKMB 1.92, CK% 0.9, Troponin I 1.650; 06 January 2014: CK 166; CKMB 1.07, CK% 0.6, Troponin I 0.541. Outcome was reported as recovered. Documents held by sender: None.