Age: 37.0
Sex: F
Vaccine: SMALL, TYP
Symptoms: Asthenia, Cardiac stress test, Chest discomfort, Chest pain, Discomfort
Clinical narrative: This 39 year old patient reported receiving her initial smallpox vaccination 22 March 2005 (left arm) along with a Typhoid vaccination. Approximately two weeks later while attending a six week military school she complained of feeling weak with flu-like symptoms that was the "worse she ever had" and daily chest pains she attributed to her "cold symptoms".  She described the chest pain as a dull ache to the left side of her chest on a scale of 6/10. This pain occurred only during the daytime resolving one hour after lying flat or by leaning forward. She complained of some shortness of breath as difficulty taking in a deep breath. She denied any radiating symptoms (head, neck, back, jaw, extremity, dizziness, or diaphoresis). She did not take any medications for this discomfort including NSAIDs when questioned nor sought medical care (in school). Approximately eight weeks post vaccination (6 weeks after onset of symptoms) she graduated from school and went home. While home, her discomfort worsened with difficulty breathing. She denied any other radating or new symptoms. She was admitted to a hospital overnight while an EKG, echocardiogram, stress test and several laboratory studies were completed. Her final diagnosis was "mitral valve regurgitation". She stated she was advised she could get treatment for this while overseas and was deployed in May 2005.  She reported also being placed on blood pressure medication (Maxide/Tropodol) which did help to ease her chest discomfort. Her duties were centered to desk work but she did wear chemical suits. While overseas she reported her pain was less often, estimating once every three days lasting up to thirty minutes. There were no specific triggers, aggravating, or relieving factors.  She reported seeing a cardiologist for her mitral regurgitation with further laboratory studies...no diagnosis or test results were given. She returned in May 2006. In June/July 2006 she sought care for chest pain once a week lasting 30 minutes duration at a 4-5/10 pain scale. Her PCP (name unknown) referred her to cardiology at a Medical Center  02 March 2007 where she was evaluated by a doctor. He diagnosed "r/o SMPX reaction" and referred her to the Healthcare Center with an EKG and stress test scheduled for 16 March 2007. During her interview with the HC 02 March 2007 she denied any active chest pain. She denied any food, chemical, latex, egg, gelatin, past vaccine reaction, environmental or drug allergies. She reported facial swelling, rash, heat with a "steroidal ear drop called Ewyash" 10 years ago. She denies any past trauma, recent/past illness (pneumonia, respiratory disease), or environmental/chemical exposures. She continues to complain of this discomfort as once a week while awake. She identifed possible worsening of symptoms when stressed or upset. Activity such as running 1/4 to 1 mile exacerbated her pain; however she would just "work thru the pain". Other activities including sitting up would trigger lesser pain that would ease when lying flat. Prior to onset of chest pain she could run up to 3 miles before having to rest. As of March 2007 she runs once a week verses daily in 2004-5, and continues to work out in the gym limiting her time to 30-40 minutes from 1 1/2 hours due to the pain and fatigue.  She denies any problems performing push ups or sit ups.