Age: 35.0
Sex: M
Vaccine: ANTH
Symptoms: Stomach discomfort, Syncope, Urinary incontinence, Vaccine positive rechallenge
Clinical narrative: Patient states he has reported to VAERS already, unsure of dates.  This previously healthy 41-year-old male received his first Anthrax vaccination on 10 November 1998.  He states he received another vaccination on November 11, 1999, as there was no documentation of him receiving a shot the previous day.  He states both arms became swollen, however he was unable to comfortablely insert his left arm into his sleeve without leaving marks.  He states there was a large red circle to both immunization sites (left greater than the right) with itching and muscular pain to the left upper arm. He denies any joint pain, paresthesia or fevers.  This discomfort lasted for approximately one week requiring use of Tylenol for pain control.   He received his second anthrax vaccination on November 27, 1998 with reoccurring swelling and redness to the immunization site.  He reported to medical where he was advised everything was ok and this was a normal reaction.   He received his third anthrax vaccination on December 17, 1998 with reoccurring swelling and redness to the immunization site that again lasted for approximately one week.  He was deployed during December 1998 to February 1999.  While there he states his right anterior thigh from groin to knee went numb.  This did not limit his normal activities, there was no weakness or tingling to the leg or skin hypersensitivity complained of.  He was advised by medical to not carry his wallet in his back pocket with no diagnosis made.  Upon his return home in May 1999, he states his wife observed his left hand was twitching while driving only.  He states he was unaware of this occurring.  Between May-June 1999 he began to report a "sensation that his head was hurting requiring him to squint" and he knew a headache was coming. He noticed an increase in the frequency of headaches with associated photophobia from 1-2 times a week in May to 2-3 times a week by June 10, 1999. The headaches were centered to the front of his head as if "migraine like" (7-8/10 decreasing to a 5/10 with medication) that required him to place his head down flat for 10 minutes. He used Excedrin migraine to ease the headaches, which allowed him to sleep.  When he awoke 2-8 hours later, the headaches had resolved.  He reports no prior history of headaches, head injuries, trauma, or visual problems.    He received his fourth anthrax vaccination on August 8, 1999.   He states his left arm and hand now frequently twitched, especially if doing fine motor activities.  He reports in September 1999, he was transferred off ship to a training facility where these tremors prompted him to seek medical care.  His wife stated his tremors now include both arms and he trembled constantly.  He reports worsening of his fine motor skills such as dropping power point pointer because he could not hold onto it.  His head began to "bob" in 1999-2000 with intermittent slurring of speech and inability to "get his words out".  He reports no know triggers such as fatigue, exhaustion, hunger, or time of day. He went to medical where he was told to go drink a beer (drank about 5-6 beers/wk on weekends at this time) to calm the tremors.  However the tremors continued and by the year 2000 they had progressed into both legs, left then right. He reports he was able to perform his annual PT test but the last three were less than normal due to extreme fatigue.  He was given an appointment with a neurologist and psychologist.  He completed the psych evaluation and was told "it was a waste of time  he was fine".  The neurologist placed him on Inderal for his headaches.  After being on Inderal for three weeks, he collapsed while running due to severe shortness of breathe.  He was admitted to the hospital for three days (find date) for a diagnosis of probable pulmonary embolism secondary to Inderal.  The medication was stopped, however the tremors and headaches persisted.  He was placed on Celexa (antidepressant) then Zoloft without change in his complaints.  Over the next year (2001), he obtained a second opinion from another neurologist who changed his medications to Myceline.  This medication helped with the tremors but made his headaches worse and upset his stomach.  He was changed to Mycelizene and MRI was performed.  He states the MRI of the brain that showed "three spots in the white matter with glycosis' and the doctor thought it was due to some past trauma".  He was placed on "terminal leave in 2002 and retired on December 31, 2002.  He continued medical care for his tremors, new onset right-sided neck pain and throbbing pain behind his ears with radiating pain to the center of right shoulder and arm.  The neck pain worsens when his right arm is extended at a ninety degree and he looks over the right shoulder.  Physicians at the hospital advised him he might have Parkinson's disease and was "set up with a memory person."  He was placed on "Neurontin 3600 mg/day" but stopped taking in June 2004 as it made him feel "funny" with mood changes and increased irritability.  He made subsequent visits to the hospital in December 2002 with complaints of bowel and bladder incontinence with difficulty maintaining erections.  He states the bowel and bladder difficulties as an inability to "hold" and "inability to get to the bathroom on time."  He denies any history of prostate disease, STD exposures or trauma to his back.  His physician advised him his "inner rectal muscle tone was weak" and he had an MRI of the lumbar spine that showed a "bulge in the lower disk."  He states the physicians recommended monitoring with no urology or orthopedic follow-up performed as of November 1, 2004.  He was given a referral to physical therapy for strengthing exercises and was released for home therapy after the fourth visit.  These problems persist as of November 1, 2004; the Vaccine Healthcare Center recommended he consult his primary physician for a neurosurgeon, orthopedist and a urologist for further evaluation of the disk bulge, incontinence, weak rectal tone, leg weakness and erectile dysfunction. Concurrently, he began to have problem with his short-term memory in December 2002.  This problem has continued as of this interview centering on difficulty in remember what was just said to him, he forgets why he is at a certain place or what he was going for.  He needs to use note pads to remember what he has to do.  He says he can drive but passes exits forgetting where he was going or the tremors make him drive out of his lane, but once he regroups he is fine.  As of November 1, 2004, he reports his tremors persist with increasing intensity and consistency.  He places his normal tremor at a 5/10 that worsens depending on the activity performed. He periodically shakes at night waking his spouse up due to the full body tremors.  He can no longer perform fine repairs due to loss of fine motor skill.  He is under evaluation at the hospital for vocational rehab.    Approximately September 2004, he observed intermittent difficulty in swallowing as if he could not get food or fluids down.  He complains of increased frequency of choking (couple times a week) that resolves with coughing.  His headaches continue to persist 2-3 times per week, with continued difficulty in word pronunciation and expression. His weakness and fatigue persist lasting a few seconds to minutes with numbness to the right knee.  He complains his leg muscles are constantly tight.    He describes this tightness as if his "legs are burning and stiffens up" making it difficult to walk requiring him to sit and rest.  He states his legs have collapsed under him with increased frequency (couple times a month) over the past 4-6 months (2004).  He was placed on Clonazepam for leg spasms with relief.  He reports no gross change in weight going from 188 to 179 lbs.