Age: 39.0
Sex: F
Vaccine: ANTH, TYP
Symptoms: Pain, Pain in extremity, Postural orthostatic tachycardia syndrome, Presyncope, Small fibre neuropathy
Clinical narrative: Patient contacted the Vaccine Healthcare Centers Network to report possible vaccine adverse events. She was in her usual state of good health which included exercising 5x/week with running, circuit weight training and dance exercise classes. Her only chronic medication was SYNTHROID which she took for controlled hypothyroidism. On 6 Feb '13 patient received anthrax vaccine #1 and the typhoid vi vaccines. The anthrax injected arm became extremely sore and she used ice packs for 2 days to relieve pain. Within 1-3 days she developed flu-like symptoms and headache. She is unsure of how long the symptoms lasted but she had documented in text messages that on 9 and 10 Feb she was too ill to participate in family activities and 2 weeks later on 20 Feb she left work early due to a migraine. On 15 Mar '13 she received anthrax #2 and again developed an extremely sore arm- so severe she could not type or write for 3 days. She reports her arm "felt like it was broken". She again developed severe flu-like symptoms i.e. headache, chills and body aches and sought medical evaluation on 21 Mar for persisting symptoms. She missed work for several days during this period and took leave from 27-29 Mar '13 to continue her recovery. She never felt totally well again. She gradually developed episodes of dizziness, fatigue, new onset migraine headaches and exercise intolerance. In Apr and May she sought treatment several times for these symptoms and was found to have both orthostatic hypotension and orthostatic tachycardia and received IV fluid infusions multiple times. Her thyroid was evaluated and found to be normal. Echocardiogram was normal. On 29 May she was admitted to MC for observation due to her multiple clinic and ER visits for presyncope. A tilt test was performed and she was found to have POTS. INDERAL, FLORINEF and midodrine were prescribed. In June '13 she was referred to Cardiology and salt tablets were added. In August '13 she was referred to Neurology where she continues to be treated for an autonomic nervous system disorder, which is characterized by both postural orthostatic tachycardia syndrome (neuropathic type) and neurally mediated hypotension. In Oct '13 she underwent additional autonomic testing at Neurology specialist. Results again confirmed postural orthostatic tachycardia syndrome. Her QSART testing was abnormal and was consistent with a postganglionic sympathetic sudomotor abnormality like that seen in small fiber neuropathy. Her current medications are INDERAL 20mg bid, midodrine 2.5 mg bid, salt supplements and SYNTHROID 88 mcg/day. Recently pyridostigmine 30mg bid was added. Patient also drinks 2-3 liters of fluids/day and uses liberal table salt. She attempts to report for work 40 hours/week but frequently requires sick days or needs to work from home. She is unable to exercise and continues to have headaches and episodes of lightheadedness and nausea upon standing. Her condition has progressed to include symptoms in multiple body systems which is consistent with dysautonomia.