Age: 54.0
Sex: M
Vaccine: ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF, FLUX, MEN, SMALL, YF, ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF, ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF
Symptoms: Chest pain, Dyspepsia, Laboratory test abnormal, Myocardial infarction, Myocardial ischaemia
Clinical narrative: Information has been received from a health authority and a health professional concerning a 54 year old male with hyperlipidaemia, degenerative joint disease of both ankles, osteoarthritis, a history of migraines (now resolved), and left shoulder surgery. The pt denies any past history of HTN, angina, CHF, CVA, valvular heart disease, diabetes, asthma, cancer or thyroid disease. The pt reported that he "sometimes" became short of breath after exercise, but that this was baseline for him. On 2/2/03 the pt was vaccinated SC with a first dose of anthrax vaccine. On 2/15/03 the pt was vaccinated IM with a first dose of hep A vaccine, a first dose given IM of hep B, a first dose given SC of yellow fever vaccine , a second dose given intradermally in the left arm  of smallpox vaccine, a first dose given SC of Menomune, a third dose given IM of influenza virus vaccine and a second dose given SC in the left arm of anthrax vacine. Concomitant therapy included Altace 2.5mg PO daily, aspirin 325mg PO daily, Imdur 30mg PO daily, Lipitor 10mg PO daily, Lopressor 25mg PO daily and Flavix 75mg PO daily. On 3/5/03 the pt was vaccinated SC with a thrid dose of anthrax vaccine. On 9/22/03 a radiologic examination revealed the lungs to be mildly hyperinflated but clear of infiltrate. The heart and pulmonary vessels appeared to be normal size. The impression was a non-specific hyperinflation and focal degenerative changes of the left distal clavicle of the AC joint. On 10/2/03 the pt recalled feeling heeartburn while resting which he described the sensation as a burning feeling in the middle of his chest and rated it as a 6 out of 10 on a pain scale. On 10/3/03 the pt was seen in the ER where he was diagnosed with a myocardial infarction. The pt's medical records noted that he had experienced intermittent chest pain/ pressure at rest for two to three weeks. He had elevated cardiac enzymes, an initial EKG with ST elevation in Lead III, and subsequent T wave inversion in leads II, III and AVF. The pt was hospitalized and underwent a  cardiac catheterization with stent placement. Mild posterior wall hypokinesis was revealed. The left heart catheterization and left ventriculogram and coronary angiogram revealed severe two-vessel coronary artery disease with the right coronary artery being the "culprit" of the pt's recent non Q myocardial infarction. The left anterior descending artery was of very small caliber. It was not optimal for surgical intervention. There was normal left ventricular systolic function. Gated apect images of the heart were obtained after the pt's recovery, which revealed the left ventricular ejection fraction is calculated to be 66% and wall motion is good. The impression from the Cardiolite Scan was an abnormal perfusion study with ischemia in the inferolateral wall region. The pt was discharged from the hospital and since his discharge he has denied any further chest pain or "heartburn" type symptoms. The pt was schedule for another stress test on 11/15/03. His recovery status is currently unknown. It was also noted that the pt stated that he was concerned that the vaccination he had received may have contributed to his cardiac problems. Myocardial infarction was considered to be immediately life-threatening and an other important medical event (OMIC). No further info is available.