Age: 22.0
Sex: F
Vaccine: ANTH, SMALL, TYP
Symptoms: Blood creatine phosphokinase MB normal, Blood creatine phosphokinase increased, Blood test normal, Chest discomfort, Chest pain
Clinical narrative: 22 y/o F contacts Vaccine Call Center on 06JAN13. CC was re NVP, but patient mentions that she was seen in the ER on 23DEC12 (day #2 s/p receipt primary SPV) for new onset of chest pain "heart racing, tightness chest/SOB." She was told that her blood work and EKG were normal. (SEE BELOW: CK was mildly elevated, no serial enzymes drawn, no PCM f/u after ER visit no repeat EKG). Patient agreed to be contacted by a NP to obtain a more detailed h/o of her chest pain / SOB to r/o possible SPV associated myopericarditis, although the onset of patient's chest tightness and slight SOB on day #2 s/p SPV is clearly atypical / early. Sx of myopericarditis generally begin during the window of the peak cytokine activity of the vaccine, which occurs between days 6-12 s/p receipt of SPV. Patient did not attempt working out again till after the Christmas/New Year Holiday. On 03JAN13 (day #13 s/p SPV) she attempted working out, but her heart began racing and she felt tightness in her chest on deep breathing, which was ongoing when NP spoke with patient on 07JAN13. At that time, her exercise tolerance was "still pretty bad" & she was not able to work out without her heart racing & tightness in her chest on deep breathing. She did not have a f/u with her PCM & she has not returned to the ER for recurrent or worsening sx. ON-CALL No contacts patient on 07JAN12 to obtain further history of patient's onset of chest pain, slight SOB and ER visit on 23DEC12. Patient confirms that she received primary SPV AVA #1 & TYPHIM Vi vaccines on 21DEC12, in preparation for work in FEB 2013. Patient denies prior viral or GI infection or any sx of anaphylaxis during first 3 hours after receipt of vaccines. States she was at church around 5PM on 22DEC12 and she felt tightness in the center of her chest, near her sternum, like someone was pushing on her chest and she couldn't breathe deeply, her heart began to race and she felt hot- episode lasted x 2 min. The next morning (23DEC12) she began to work out and tried to run. Within 2 minutes her HR had increased to > 170 bpm & she had to stop. She states that she is an endurance runner and has never experienced these symptoms before. She tried doing some lunges, but her chest was still hurting. No radiation of pain to her neck, jaw or left arm. CP not positional, but she was not supine. She read the smallpox vaccine pamphlet she had been given and called the Vaccine Call Center, as noted above. When the tightness in her chest and slight SOB recurred again around 14:30PM, she decided to go to ER and get it checked out (SEE ER Note, 23DEC12, 14:59). EKG obtained (23DEC12, 15:54) with "no ischemic changes"; ER VS (1600) BP 137/72, HR 78, RR 16, T 97.1 F and (1700) 133/76, HR 78, RR16, T 96.1 F. (SEE LABS BELOW- CK 147 U/L (30-135) / no serial enzymes drawn). No echocardiogram obtained. ER Dx: Immunization Reaction (not Myocarditis). Patient was home over holiday and did not attempt working out again till 03JAN13 (day #13 s/p SPV). Her heart rate increased very rapidly & she felt tightness in the center of her chest, which was worse with deep breathing.