Age: 26.0
Sex: M
Vaccine: SMALL, SMALL
Symptoms: Electroencephalogram abnormal, Electrophoresis protein normal, Epstein-Barr virus test negative, Exercise electrocardiogram, Fatigue
Clinical narrative: This case was received on 26 April 2011 via a third party query tool search on the VAERS database, under reference number 416353. A 26-year-old male patient received ACAM2000 (lot number VV04003A) on 12 August 2009. In addition, the patient had received the following vaccines on 11 August 2009: typhoid (manufacturer and lot number not reported), anthrax (manufacturer and lot number not reported), and meningococcal (manufacturer and lot number not reported). Over the next few days, he described a robust take to smallpox vaccine, described as red pustular near, site swelling, left axillary tenderness, and nodal swelling. One to two weeks later, he complained of shortness of breath on inspiration with a squeezing sharp midsternal stab "something pushing inside trying to get out vs sitting on chest; 6/8/10 pain scale", not affected by position. Symptoms were unrelieved by MOTRIN, and resolved after 4 days on 01 September 2009. He received another dose of anthrax vaccine and FLUMIST (other manufacturer) on 29 September 2009. On 08 -22 October 2009 he was treated with steroids for contact dermatitis/rash. On 22 October 2009, he was seen in follow-up and complained of a 3-day history of fever, chills, congestion, sore throat, headache, cough, and wheeze. He was diagnosed with bronchitis, and symptoms resolved 2 weeks later. He received the H1N1 pandemic influenza vaccine (manufacturer and lot number not reported) on 13 November 2009, and deployed in December 2009. On 18 January 2010 he complained of difficulty breathing, and wheezing with exertion. Due to a strong family history of cardiac disease, he was sent for cardiac and pulmonary evaluation; results were within normal limits. On 17 February 2010 he complained of unwitnessed syncopal-like episodes with no loss of consciousness; however, legs were "buckling with fatigue walking/standing" greater than 10 minutes. "Muscles went to collapse". No paresthesia, incontinence, or visual disturbances were reported. In March/April 2010 he complained of dizziness standing, chest pain, palpitations, knees buckling, bradycardia, and headaches. Following a comprehensive cardiac evaluation, he was advised that his chest pains were "unrelated to presyncopal symptoms". In April 2010 a neurological examination diagnosed vasovagal syncope with possible hyperventilation syndrome without overbreathing. He was also diagnosed with migraine headaches secondary to poor sleep. Sleep studies were consistent with sleep deprivation. He was seen by an ENT and treated with septo-turbo-adenoidectomy for turbinate hypertrophy with improvement in breathing and smell, but no change to fatigue. In May 2010 he experienced episodic bouts of upper extremity weakness including difficulty with fine motor control of the hands with repetitive actions or holding/carrying items over 10 pounds. He continued to have lower extremity weakness. A psychiatric evaluation resulted in a diagnosis of anxiety disorder. At the time of the report, a comprehensive evaluation was in progress; recovery was unknown. Documents held by sender: None.