Age: 55.0
Sex: F
Vaccine: SMALL
Symptoms: Chest discomfort, Heart rate increased, Injection site erythema, Pain, Palpitations
Clinical narrative: Tachycardia and chest pressure March 22 through April 1 (saw MD April 1 but did not mention smallpox vaccination).  Rebast take with pain and selling down to elbow March 21-April 5. Saw MD April 1 but did not mention tachycardia or chest pressure.  Smallpox vaccine was given on March 18, 2003.  On April 18 in answer to CDC Surveillance Sheet interview, Pt told the reviewer that from day 4 through at least day 14 (March 22 through April 1) she had palpitations and her pulse rate was between 100 and 120 even when resting. She also reports that she had a very robust take and had redness much greater than 3 inches around the site and had painful swelling down to her elbow from day 3 until around day 18 (March 21-April 5). She states that photos were taken of her arm on March 26 when she was observed. She had vacation time off preplanned from March 20-25 so did not take any sick time off work. She had difficulty bending her arm or even using it. She states that she die NOT report the palpitations or tachycardia to the site review nurse or the Public Health Physician. She states that she had symptoms of chest tightness on April 1 but thought it was because of a busy and stressful schedule at work. She was seen at her private physician's office on April 1 (day 14) for a preplanned appt not related to the symptoms. She states that the nurse took her pulse and it was 105. She states that the doctor rechecked it and the rate was about the same. She reports that the doctor suggested that the tachycardia might be due to her thyroid medication, although the dosage had been the same for some time and was not altered at that time either.  She had thyroid testing done and has not heard the results. Pt reports that she did NOT tell her doctor that she had received the smallpox vaccine and did not tell the doctor about the sensation of chest pressure she was experiencing. Pt reports that for several days now she has not had any tachycardia and her pulse now is usually 72. She reports that soreness continues in her arm even though the swelling has subsided. The follow up received on 5/28/03 states smallpox vaccine was given on 3/18/03. On 4/18 in answer to the vurveillance sheet interview, pt told the reviewer that from day 4 through at least day 14 (March 22 through April 1) she had palpitations amd jer [i;se rate was betweem 100 and 120 even when resting. She also reports that she had a very robust take and had redness much greater than 3 inches around the site and had painful swelling down to her elbow from day 3 until around day 18 (March 21 through April 5). She states that photos were taken of her arm on March 26th when site was observed. She had vacation time off preplanned from March 20 through March 25th so did not take any sick time off work. She had difficulty bending her arm or even using it. She states that she did not report the palpitations or tachycardia to the site review nurse of the public health physician. She states that she had symptoms of chest tightness on April 1st but thought it was because of a busy and stressful schedule at work. She was seen at her private physician's office on April 1st (day 14) for a preplaned appt not related to the symptoms. She states that the nurse took her pulse and it was 105. She states that the doctor rechecked it and the rate was about the same. She reports that the doctor suggested that the tachycardia might be due to her thyroid medication, although the dosage had been the same for some time and was not alterred at that time either. She had thyroid testing done and has not heard the results. Pt reports that she did not tell her doctor that she had received the smallpox vaccine and did not tell the doctor about the sensation of chest pressure she was experiencing. Pt reports that for several days now she has not had any tachycardia and her pulse now is usually 72. She reports that soreness continues in her arm even though the swelling has subsided. The pt was contacted by a PHN in response to a request from MD for any clinical data. Pt states that her visit to the doctor on April 1 was pre-planned and was for a different problem. She states that the visit was not pertinent to the smallpox vaccine or tachycardia. She states that her pulse was 105 at that visit. NO EKG was done. She states that her thyroid test that day was "the same" and she continues on the same dosage of thyroid medication. When asked about other lab tests, she states that blood was drawn for other testing but it was for a different problem that had nothing to do with the tachycardia. She again states that she did not tell her pysician that she had received smallpox vaccine. She states that she does not wish to share any other information because she is fuly recovered from the tachycardia and any other information is private.