Age: 39.0
Sex: F
Vaccine: ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF, ANTH, FLUX, HEPA, MEN, SMALL, YF, ANTH, FLUX, HEP, HEPA, MEN, SMALL, YF
Symptoms: Anorexia nervosa, Blood creatine phosphokinase increased, Chest discomfort, Chest pain, Myocardial infarction
Clinical narrative: From initial information received on 2/5/04 and additional information received on 2/10/04 from the Centers for Disease Control and Prevention regarding an adverse event occurring in the USA, it was reported that a 39 year old female patient received a first dose of YF VAX, lot number not reported, administered SC, a first dose of BIOTHRAX, lot number FAV073, administered SC, a second dose of HEPATITIS A VACCINE, lot number not reported, administered IM, a first dose of HEPATITIS B VACCINE, lot number not reported, administered IM, a fifth dose of INFLUENZA VACCINE, lot number not reported, administered IM, a second dose of MENOMUNE A/C/Y/W, lot number not reported, administered SC and a first dose of DRYVAX, lot number 4020071, administered ID on 1/29/03. Sites of administration were not reported. One week after receiving the vaccinations, the patient started to experience chest pain. She experienced similar chest pain the second week in February and at the end of March. She did not seek medical care until the chest pain episodes returned on 5/20/03. Patient reportedly was diagnosed with a non Q-wave myocardial infarction. Diagnostic tests revealed an elevated CPK (peak of 317) and elevated troponin (result not reported in available medical records), the patient was medically evacuated to a medical center. While at the medical center, her cardiac enzymes shoed to be abnormal with a peak CK of 98 (normal), elevated CK MB of 12, and elevated troponin of 21. A cardiac cath revealed a right dominant coronary system with branch vessel disease. The patient had a very small first obtuse marginal branch that had a 90% ostial lesion in it. She also had a 60% ostial moderate size diagonal branch lesion. Given the findings and continuous chest discomfort, the patient remained in the ICU and was placed on a full Bruce treadmill test. She did not develop any ischemic ECG changes on the treadmill. The patient's physician's did not feel that her chest pain was cardiac related. A PA/lateral chest x-ray revealed a blunt right hemidiaphragm consistent with a small effusion. The patient was hospitalized for three days. A repeat chest x-ray, obtained five days later, showed that the effusion had resolved. An abdominal ultrasound was performed, which was unremarkable other than a non distended gall bladder. A gastroenterology consult was obtained and an esophagogastroduodenoscopy was  performed, which revealed a small erosion on the antral portion of the stomach, but was not felt to be causal of the chest pain. She was placed empirically on Aciphex. While at the medical center, a psychiatry consult was obtained to evaluate the patient's eating habits, and she was diagnosed with anorexia nervosa of a restrictive type. No medications were started for this. She stayed at the medical center for 2-3 weeks before being transferred to another medical center for further evaluation. Her discharge medications include Lopressor 25mg twice daily, Plavix 75mg daily, Aciphex 20mg twice daily and Zocor. On 6/6/03, during cardiology evaluation, her EKG showed NSR, NL EKG. GXT Thall obtained on 6/9/03 showed moderate to severe diminished activity in her anterolateral wall after 12:56 minutes, which improves with rest. EF-55%, TTE (6/10/03): normal echography with EF 60-65%. Physician indicated that although her MPS showed ischemia in the anterolateral wall, her ability to exercise for 12:55 minutes without cardiac symptoms translates in a good prognosis. He also reported that the patient's chest pain was non-cardiac , but most likely musculoskeletal in nature and referred her to internal medicine. It was thought to likely be costochondritis and she was referred for an PA chest x-ray, which the records indicate were normal. At the time of vaccination, the patient also took vitamin E. After her myocardial infarction, she started Librax daily for hiatal hernia, rabeprazole 20mg twice daily, atenolol daily, Darvocet 100mg every eight hours as needed for pain, nitroglycerine spray as needed for chest paina nd an Epi-Pen for emergency use. Reportedly, the patient did not recover from these events. Additional info received 27FEB2004 through another company: Information was received which pertained to events that occurred 48 days after vaccination. This information contained the following adverse experiences: small effusion and anorexia nervosa. Chest pain and myocardial infarction were considered to be life threatening and to be other important medical events. Additional lab information was also provided. From additional information received on 04MAR2004 from the minutes of the CDC Yello Fever meeting, on 09FEB2004, it was reported that the pt did not seek medcal care until 20MAY2004 and was diagnosed with a myocardial infarction on 21MAY2003. No additional relevant information was provided for the adverse experience. This specific version is not submitted to the Health Authorities.