Age: 33.0
Sex: M
Vaccine: ANTH
Symptoms: Colonoscopy normal, Diarrhoea, Dyspnoea, Echocardiogram normal, Electrocardiogram Q wave abnormal
Clinical narrative: This 36 year old reported receiving his first anthrax vaccine (AVA) on 1/12/2009, 2nd AVA and primary SPV on 2/24/2009 and 3rd AVA in 1/2010 (no date found for third AVA). He reported experiencing sudden onset of watery non-formed to soft pudding like stools 3-5 times/week sometime after receipt of AVA 1 or 2 bur was unsure exact date onset. He stated his stomach would gurgle loudly, and then he would be in the restroom every "5-30 minutes" for one hour then okay for 2-3 hours before this cycle would repeat. He also admitted to some nausea but denied any fever, abdominal cramps, back aches, urinary problems or problems with bowel problems. He advised past bowel movements were 1-2 formed stools per day. These events did interfere with his ability to work. He did report to medical but does not recall the diagnosis as other cardiac health issues were being investigated (see below). He advised receipt of AVA #3 in Jan 2010 his bowel movements were "mostly liquid". Concurrently he complained of acid reflux with episodes of diarrhea (again unsure of date onset). He advised his "food wanted to come back up after eating...burped a lot". He denied any new foods or change to diet but food made him run to the bathroom. He also advised eating made his throat feel bad-burned 3-5 times/week. This has continued for 3 years (2009-2012) with no resolution with change in diet (easing out dairy, egg, caffeine, sugar, and wheat from diet), or with use of medications (MAALOX, TUMS, PEPCID, ZANTAC, etc). As of 2012 he continues to experience episodes of "diarrhea" 3-5 times/week having "10 bowel movements per day" which he describes as solid to liquid pudding like consistency". Otherwise his stools were normal or hard. He also advised with receipt of SPV on 2/24/2009 his left arm vaccine site developed pimple like blisters which developed into a scar and was treated for a "mild heart attack". He reported he was on convalescent leave for 33 days (see note 9/18/2009 and 2/29/2010...provider documented cardiac eval with medical record review; however these records are not available to this provider). A review of his medical records (consults) identified on 4/22/2009 he was referred to cardiology, for acute onset of atypical chest pain that was relieved with nitroglycerin with subtle EKG changes.EKG changes were reported to be non-specific borderline pathologic Q waves in lead I and AVL", and normal troponin x3. This cardiac referral gave a provisional diagnosis of "chest pain, abnormal EKG and rule out myocardial infarction". His records mention cardiology evaluations on 4/29/2009 and 5/18/2009 with normal CT angio, echo, and stress test. In 2010 he complained of shortness of breath and elevated heart rate from 60 to 100 bpm at rest and 189-196 beats with workouts. He advised he works out 2-3 times per week. As of 2012 he still complains of heart rate at 196 with exercise only, is training for 1/2 marathons and walks 6-7 miles/week. Is still short of breath which he describes as "if I just finished a workout...need to breath in more" and complains his heart rate will not go back to 60's like it did before given AVA/SPV. A review of his medical records documented average heart rate in 2005 as 64-84 bpm, 2006 67-88 bpm, 2007 87-112 bpm, 2009 80 bpm, and 2010 89-93 bpm.