Age: 19.0
Sex: F
Vaccine: SMALL
Symptoms: Sneezing, Swelling, Troponin I normal
Clinical narrative: This case ws received 04 DECEMBER 2013 via a third party query tool search on the VAERS database, under reference number 502884. A 19-year-old female patient had received the following vaccination on 16 AUGUST 2013: ACAM2000 (lot number VV04003A) in the upper left ar. She was in her normal state of good health at the time of vaccination. The patient had a recent history of difficulty falling asleep an staying asleep which she attributes to personal issues. On 17 AUGUST 2013, she noted sniffles and sneezing with no other symptoms. ON 18 AUGUST 2013 she noted generalized malaise and sniffles. The patient dismissed local site reaction symptoms (erythema, swelling, lymphadenopathy). On 19 August 2013, when she awoke and at up the noted "soreness" (rate as 3/10) across her upper sternum which increased slightly with deep breaths and palpitation. She continued with her normal routine (she thought that the discomfort/"soreness" was from sleeping on her stomach). While at work  at 08:15, she noted an increase in the soreness to a 6 which lasted about 5 minutes. She felt "hot and weak" and the pain increased with deep breaths. When she was triage in the ER at 09:22 her discomfort was a 4/5. She had a negative Troponin (0.012 mg/ml), normal chest ex-ray (CSR) and an EKG which showed NSR with no ST elevation. She took 800 mg MOTRIN at 16:00 and when she woke from a nap her pain was a 1/10. On 20 AUGUST 2013, she still had the sniffles and she had a headache (frontal and temples: 2/10; described as annoying which she attributed to a lack of sleep) and "chest" discomfort (1/10) upper 1/4th of the sternum which increased slightly with deep breath and palpation. The patient denied a history of GERD, reflux or recent  indigestion. She reported that the staff in the Immunization Clinic had started "circuit workouts" the previous week. She dismissed palpitations and the discomfort was non-positional. The lateral aspect of the upper sternum was tender to palpation. She was instructed to take 800 mg of MOTRIN tid with food and was given a no PT chit until her follow-up appointment on 28 AUGUST 2013. On 29 AUGUST 2013 she reported that she experienced 1/10 chest until 23 AUGUST 2013 what which time her previous symptoms (headache, chest soreness, malaise) resolved. The patient stopped taking the MOTRIN on  23 AUGUST 2013. The patient states that her "sniffles" have almost received. The patient did note a small amount of erythema (1 cm) around the v vaccination site and mil axillary lymph node tender which started on 22 AUGUST 2013. There was no tenderness noted to the upper sternal border when palpated. IT was the consensus of VHC expert opinion that the patients condition does not meet the case definition of pericarditis or myocarditis, but was non-cardiac in nature possibly related to costochondritis, possibly an inflammatory response from the SPV or the patient's recent expanded  exercise regimen. Laboratory data included on 19 AUGUST 2013 Troponin I 0.012 ng/ml; CKMB 0.76 ng/ml; Chest X-Ray (CXR); wnl;  EKG: NSR with no ST elevation. The patient outcome was recovered on an unreported date. The event of costochondritis was not included in the coding from the VAERS database but had been mentioned in the narrative and was coded for this case. There may be a discrepancy between the event date field and the onset date information in the free test narrative field in the data reported. Latency has been calculated using the event date.  Documents held by sender: None