Age: 41.0
Sex: M
Vaccine: FLU3, HEPA, IPV, MEN, MMR, TD
Symptoms: Arthralgia, Asthenia, Decreased appetite, Fatigue, Migraine
Clinical narrative: Migraines, polyarthralgias, persistent nausea with onset following receipt of multiple vaccines.  41 year old male with concerns about a decline in his health following receipt of multiple vaccines prior to his deployment in 2004.  Patient reports new onset migraines, persistent nausea, and joint pain.  Prior to deployment was healthy, with no activity restrictions or other limitations due to health problems.  He is currently undergoing a medical board evaluation.  On 05/03/2004 - not sure what arm he received immunizations.  Does not recall significant swelling, redness, or itching surrounding vaccine sites.  Recalls some tenderness at vaccination sites lasting about 1 week.  About 24-48 hours after vaccine receipt, recalls that it felt like he was "getting the flu" and began treating with over the counter medications.  (He thinks he took Tylenol Cold and Flu tablets.)  Symptoms included tiredness, felt weak, nauseated with decreased appetite, and generalized body aches.  He does not recall experiencing a fever or chills.  Most of these symptoms gradually improved.  After about 3 weeks from onset, he felt like he was functioning better.  At the time, he attributed the symptoms to the flu or jet lag and adjusting to his new environment.  At the end of May, he continued to experience nausea.  During the flight to Germany on 05/05/2004, patient experienced a severe headache, primarily manifested as severe pressure on the right side of his head.  The flight personnel broke an ammonia inhaler to help relieve the pressure; he recalls it helped him to tolerate the remainder of the flight.  He does not recall a recurrence of the severe headaches, until about 3 months following his initial episode.  Then, he started having severe headaches about 4 times per month.  At that time, he related the headaches to increased stress and being tense and on the edge and he thought they would resolve.  During the first week following vaccine receipt, patient reports that his eyes were really red and itchy with increased tearing; he self treated with Visine, but the next week, the symptoms were getting worse.  He then sought medical evaluation and was seen at the eye clinic.  He recalls that they did  cultures and gave him a prescription for eye drops and ointment for 1 week; within a few days of initiating treatment, his symptoms started clearing; they were completely resolved by 1 1/2 weeks.  Around July 2004, which was about 2 months post-vaccine receipt, patient started experiencing joint pain in his ankles, hands, elbows, and neck.  He sprained his left ankle in July 2004.  Initially, the pain was most prominent in the neck.  Around Mid-July or August, he started having lower back pain with associated symptoms of shooting pains and spasms down his legs, and numbness and buring sensation in his thighs and feet.  He had problems with his right leg dragging and would slip and slide.  He says he almost had bladder incontinence.  His evaluations ruled out Multiple Sclerosis.  In October 2004, his x-rays showed L4-5 degenerative disc disease and his MRI in October, showed multilevel degenerative disc disease of thoracic and lumbo-sacral spine.  Currently, his ankle pain varies in intensity.  On bad days it is hard to walk.  Most recently, he has also developed pain in his upper back, around kidney area on both sides described as aching pain.