Age: 34.0
Sex: M
Vaccine: ANTH, TYP
Symptoms: Injection site nodule, Insomnia, Joint stiffness, Memory impairment, Mental impairment
Clinical narrative: Pt is a 38 year old who received seven anthrax (AVA) immunizations from Apr 1998- Oct 2000. Other than burning and the development of a localized nodule that persisted for a couple of weeks, he reported no immediate problems.  In Mar 01, approx 5 months following AVA # 7, he noticed pain in the back of both knees and calf discomfort. The right knee was more painful than the left. Radiology exam noted some calcification and ultrasound identified a bilateral Bakers Cyst and a slight tear in his meniscus. Also upon return from the desert, he began to notice problems with sleeping. He stated he would lay awake and be unable to fall asleep. When he would fall to sleep, he would have problems arousing in the morning. Some days he would sleep 4-5 hours and other days he would not sleep. He never felt rested.  He reported only calf and knee pain at this time, but he noticed an increase in his back and neck pain due to a previous MVC in 1989. He now more pain in his joints and developed tingling in both legs. He describes this tingling as intermittent and is unable to associate it with any activity. Upon arrival, he was reevaluated by orthopedics and he began to have trouble with climbing stairs due to his knee pain. His knees are stiff in the morning and pain would increase with activity but noticed that the stiffness would decrease with activity.  Also, in the fall of 01, the knee pain began to keep him awake at night and he felt fatigued. At times, he would not sleep for days and even with sleep, he felt exhausted. He stated he would spend days just lying on the couch.  Between Nov 01-summer 02, he noticed periods of diarrhea and constipation. He reports that constipation is more common that the diarrhea. He stated that in Jan 03 he was diagnosed with Fibromyalgia and Irritable Bowel Syndrome. He also stated that during sleep studies it was discovered that he had restless leg syndrome. He stated he did not realize he had restless legs. Currently he states the pain is now in all his muscles. The area between his shoulder blades would burn and feel prickly. He also experiences this feeling in his arms. States he would have muscle spasms in both arms equally, sometimes legs, and rarely in the face. He also noted pinpricks and a hot feeling of his buttocks and legs. He would at times notice radiation of this feeling from his shoulders to his buttocks.  During the summer of 02, he began to notice problems with his short term memory and problems focusing. He could not remember where he parked his car, but noticed this problem especially when he was in pain. He stated that he felt emotionally drained.  States he currently loses tract of time. He stated that there are times in which he can't remember which day it is and it has caused him to be late for appointments. He has at times slept through an entire day or two. He says this is not interfering with his ability to work and that he has been evaluated by neuro and had a normal MRI. He also stated that his memory is not as sharp as it was in the past. Now unable to remember numbers, fine details, and has to really focus and write things down. Prior to this time, he could remember many facts and appointments without writing things down.