Age: 23.0
Sex: M
Vaccine: SMALL, SMALL
Symptoms: Malaise, Mitral valve incompetence, Mycoplasma test negative, Myocardial necrosis marker increased, N-terminal prohormone brain natriuretic peptide increased
Clinical narrative: This is a follow-up to a previously submitted VAERS report 391192-1. This 23 year old (engineer) received his primary smallpox vaccine (ACAMBIS VV04-003A) on 10 June 2010. Prior vaccinations included AVA #2 on 18 May 2010 and AVA #1 with Typhoid booster on 5 April 2010. Approximately 17 June 2010 (day 7) after working outside in 100+ degree heat then working concession at concert (no AC) that evening he began to feel weak, lightheaded, with generalized malaise. He thought he was dehydrated and increased fluid intake over next 24 hours with minimal relief. By Saturday 19 Jun 2010 (day 9) his fatigue worsened being unrelieved with 8 hr sleep and a 4-5 hour nap (never took naps). He began to experience a dull aching chest pain about 1200 noon while at rest. That evening he drank 3 bottles PEDIALYTE, felt better and was able to sleep. He awoke about 4 am Sunday morning sweating profusely feeling weak, groggy, "hot" (subjective fever), and was having difficulty breathing. He stood up, took 2 steps and fell complaining of 10/10 midsternal chest pain. He did not injure himself with controlled fall to knees/ground. He presented to Hospital Emergency Room at 0432 20 Jun 2010 (day 10) complaining of 2 days of increasing fatigue/tiredness with decreased appetite and 16 hours of chest pain. He described his chest pain "as if his chest was on fire". He had an achy, burning, sharp 8-10/10 midsternal chest pain that worsened with inspiration and activity (such as walking). He was short of breath, felt hot, diaphoretic, nauseated, and vomited x 1. He denied any radiation to neck, back or arms, headache, visual changes, rashes, edema or palpitations. Providers documented he was afebrile, moderate distress, pale and diaphoretic otherwise his physical exam was normal. An EKG showed ST elevation in inferior-lateral leads. His cardiac enzymes were significantly elevated (see below). Initial treatment included ASA, Morphine IV, ZOFRAN IV, and NTG drip 5 mg/min. He was taken for emergent cardiac catheterization with an EF 20-25% (see below) and admitted to intensive care unit. He was placed on Carvedilol 3.125 mg, Lisinopril 2.5 mg, Hydrocodone 500 mg, and MOTRIN 400 mg. Subsequent echocardiogram at 0757 on 6/20/10 post cardiac catheterization showed EF at 35% with evidence of inferoposterior wall hypokinesis. He advised his chest pain was not affected by position and eased to 5/10 with medication alone taking 2-3 days to fully resolve. His O2 sats on room air were 98% 6/20/10 despite complaints of shortness of breath. An ABG 6/21/2010 identified PO2 of 67 with O2 sats 93.5 on O2 6 liters per simple face mask (see below). A repeat CXR 6/22/10 showed "development of interstitial pulmonary edema, LLL consolidation and effusion." He was on oxygen for 3 days before complaints of shortness of breath fully resolved with room air O2 sats at 95%. Viral studies completed by Infectious Disease (ID) were positive only for Coxsackie B virus IgG (see below).