Age: 23.0
Sex: M
Vaccine: ANTH
Symptoms: Ultrasound abdomen abnormal, Urinary tract infection, Urine analysis, Urine ketone body present, Visual field defect
Clinical narrative: Summarize HPI: Review of events per patient's recall and review of available medical records:  1) 4/2/2015 Patient cleared for work   2) 7/9/2015 AVA #1 (FAV427A-Emergent) to left arm  3) 7/10-11/2015 flew to another location  reports good health.  On arrival 7/11/2015 states restaurants closed for holidays so did not eat/drink until onboard ship 7/12/2025.  4) 7/12/2015 Once on ship, patient reports urine was dark-looked like blood  medical advised and told had elevated ketones (UA machine broken).    5) Patient reports about day 3-4 post vaccination he felt weak and sluggish describing this as objects were heavy to move/lift/carry and he experienced shortness of breath climbing stairs between decks (difficult to take in deep breaths), and stated while on the bridge his vision would black out for few seconds (returned if relaxed and stood still).  6) 7/14/2015 Medical records document first medical exam with c/o increased urine color x2 days and c/o neck pain.  UA dip stick on ship suggested RBC and ketones. Was clinically dehydrated and sent to shore medical (Hospital) where diagnosed with Urinary Tract Infection, hematuria and dehydration.  Records document electrolytes, glucose, BUN/Creatinine, routine urinalysis, glycosylated hb, and Rello check 4.4 mmol/L ordered (no lab values documented) and US abdomen offered but refused as "had to travel".  Patient offered IV fluids but declined preferring IV on base. Patient stated was told his labs were normal.  Patient recalls 7/14/2015 or day 5 that he was hot to touch with hot/cold chills, shivering and was restricted to his room for 12 hours.  He recalls he could not eat over next 1-2 days and vomited x1.  7) Patient states he had a headache and dizziness day 7 post vaccination and still had difficulty eating and drinking due to nausea, lack of appetite.  He stated he had no veins for IV access and was encouraged to drink water/fluids.  8) 7/19/2015 (day 10 post vaccine) he reports losing about 18 pounds due to continued n/v/d.  Records document a follow up exam on base for c/o loss appetite x9 days (eats 4-5 bites then nauseated, no vomiting), cough, congestion x5 days, and peripheral vision "blackout" x 30 seconds with no LOC while standing still on the bridge.   Medical exam was normal with Temp 101.5-102.5F, heart rate 116, and respirations 14, BP 104/66.  Labs showed UA with ketones, small amount blood, trace proteins, color dark yellow, and specific gravity 1.030.  IV's infiltrated x 2 and 3rd try was a miss.was given oral fluids and diagnosed with Fever Unknown Origin and dehydration.  9) 7/20/2015 to 7/25/2015 he was followed by ships medical twice a day for vital signs and follow up exams (while at sea).  Patient continued to c/o poor/loss of appetite, nausea, fever, lethargy.Heart rate average 115-124 bpm. EKG not available on ship. Temperature varied from 98.9 to 100.3 on Septra and Tylenol. Mono test was negative. UA: large ketones, ph 6.5, and SP 1.015-1.025.    10) 7/25/2015 seen by shore physician with exam normal.  Abdominal ultrasound suggested questionable renal calculi vs UTI and MD diagnosed dehydration/tachycardia with UA negative for ketones/hematuria. He was cleared to fly home for further evaluation of this unknown illness.  11) Patient advised once home, he continued to feel weak, lethargic/tired, could only eat cheerio's and slept a lot. He recalls his family stating he was ashen, eyes red and irritated.   12) 7/27/2015 follow up with medical reporting he was "better" with records documenting ketones in UA and elevated liver enzymes (which ones?). He stated he did see his HCP about 2 days after home or early August and was put on Augmentin for an unknown illness.     13) Follow up exams by medical on 8/12/2015 patient felt better and all labs normal (specific labs tested for not recorded).  8/17/2015 patient advised was back to his normal self.