Age: 40.0
Sex: M
Vaccine: ANTH
Symptoms: Pain in extremity, Prostatic specific antigen increased, Prostatomegaly, Urinary tract disorder, Vaccine positive rechallenge
Clinical narrative: Immediately had localized pain in left arm and swelling.  This was followed by difficulty in urination that began about 5 days later.  Followed up with primary care physician who was not familiar with Anthrax vaccine or requirement for vaccine.  Spoke with military treatment facility which does not provide care for reserve soldiers.  Received next Anthrax vaccine two weeks later.  A large two inch spot on right arm on area where injection was made.  Had overall body ache and headache that persisted for three weeks.  Received next Anthrax vaccine two weeks later.  Received on right arm.  A large three inch spot on right arm with swelling and pain.  Urinary problems to include enlarged prostrate persisted since receiving vaccine series. Pt received his initial 3 anthrax vaccines in March/April 1999. Following receipt of AVA (1), he describes a local reaction with onset within 2 hours of vaccine receipt, worsening over the next 24-48 hours and resolved completely after 5-7 days. The vaccination site was red, tender and swollen (about the size of a 50-cent piece). The itensity of site tenderness was rated as 4-5/10 using a paon scale of 0 (=no pain) to 10(=worst pain ever experienced). He self treated with TYLENOL, which decreased the tenderness. He also had a marbel-sized nodule that almost completely resolved after 2 weeks and had some bruising at the vaccine site after the redness and swelling resolved. He reports pain radiating down his left arm which lasted a few hours after vaccine receipt. Systemically. Pt experienced new onset generalized body aches and joint pain in fingers and left elbow within 24 hours of vaccine receipt. The myalgias and arthralgias are described as "achiness" and rated as an intensity level of 7/10 on pain scale. There was no redness, swelling or increased warmth affecting his joints. The pain decreased slightly after taking TYLENOL. The myalgias and arthralgias were continued intermittently over the next 10-14 days. Pt experienced dysuria approximately 5 days after receipt of AVA (1). He denies fever chills or headaches. Pt received his 2nd anthrax vaccine on 3/20/99. He reports experiencing a similar local reaction "except worse". The affected area extended approximately 2" around the vaccine site and the pain was rated as 5-6/10. He experienced a subcutaneous, marble-sized nodule at the vaccine site that lasted about 2 weeks. He denies pruritis at the vaccine site. Within 24 hours of vaccine recept, pt experienced similar, but more intense arthragias and myalgias intermittently until receipt of his 3rd anthrax vaccine. He also experienced a perssistent headache affecting the top of his head. The headache was not typical of previous headaches. The pain is described as sharp and rated as a pain intensity level 6/10. His headache pain decreased with TYLENOL, but as the TYLENOL wore off, the headache recurred and intensified. He denies accompanying symptoms like photophobia, nausea or visual changes. The headache was constant for almost 2 weeks. Pt continued to experienced dysuria but does no recall a worsening or significant change after his 2nd anthrax vaccine. About  3 days after vaccine receipt, pt was so uncomfortable the he inquired regarding authorization for evaluation of his symptoms, but was told a visit was not authorized.