Age: 46.0
Sex: M
Vaccine: ANTH, HEP, HEPA, SMALL, TD, TYP
Symptoms: Chest pain, Injection site pain, Tension
Clinical narrative: 47 yo AA male who presented to the Vaccine Healthcare Center with a complaint of chest pain that has recurred after he has received each of three anthrax vaccinations.  He has a past medical history of HTN, hyperlipidemia.   See timeline below: On August 14, 2003, he received Anthrax #1 (R arm), Smallpox (revaccinee) L arm, Hep A #1, Hep B #1, Typhoid, and TD.  He states that as soon as he received the anthrax vaccination, he felt a "funny sensation" from the anthrax vaccination site to his chest.  He describes it as muscle tension.  He denies any dizziness, abd pain, itching, rash, or trouble breathing at that time.3-4 hours later, he states that the pain became severe and he went to see his physician.  He describes the pain as "severe muscle tension."  He compares it to the muscle sensation you get after a hard workout, but he states this sensation actually hurt.  He had not done any strenuous exercise prior to or after receiving the vaccine.  He rates the pain as an 8 on the pain scale (0-no pain to 10-worst pain ever).  He states that it was a constant pain that did not change with movement, position changes, or breathing.  He describes the pain as spreading all across his chest but states that it was worse over his sternum.  He denies any shortness of breath, nausea/vomiting, abdominal pain, dizziness, rash, itching, cough, or trouble swallowing.  Per his report, he was given sublingual nitroglycerin while at doctor's office once without any relief.  He states that he had a normal EKG.  No labwork was done.  He was allowed to go home but was scheduled for a Stress test that he reports was normal.He states that when he left the doctor's office, his pain was down to a 3 on the pain scale.  It was the same as described above but less severe.  He states that it lasted approximately two more days and then eased off on its own.  He did not take any medications for the pain.  On 04 Sept 03, he received Anthrax #2.  No local or systemic symptoms on the date of the vaccination, but he noted a similar but less severe pain in his chest two days later.  He rates it as a 4 on the pain scale.  The location was across the top of his chest with slightly more intense pain over his sternum.  No radiation of the pain.  He describes it as a constant pain that lasted all day but then eased away.  He did not seek medical attention on this date.  He does not recall what he had to eat on this date.  No history of GERD.  On 15 Sept 03, he received Hep B #2 and reports no local or systemic reactions, including chest pain from this vaccination.  On 05 Dec 03, he received his influenza vaccination and reports no local or systemic reactions, including chest pain, from this vaccination.  On 28 Feb 04, he received Hep A #2 and Anthrax #3.  He experienced no local or systemic symptoms on the date of vaccination.  He states that 1 week later around 10 March 04, he experienced a light chest ache (1-2 on a pain scale) for two days and then slightly more severe pain on the third day (3 on a pain scale).  He had no other local or systemic symptoms.  He states that he went to Occupational Health to report the reaction.  He was advised to go to the Emergency Room.  He was evaluated at a Medical Center and reports that he had a normal EKG, labwork, and chest x-ray.  He was discharged home and by the next day, he reports that he was no longer experiencing any chest pain.