Age: 23.0
Sex: M
Vaccine: ANTH
Symptoms: Pruritus, Rash, Seborrhoea, Sleep disorder, Urticaria
Clinical narrative: Concerned about frequency and duration of facial rash, lip/mouth swelling, diffuse itching with resulting hives to knees, arms, feet, chest, hips; joint pain to right and left arm, hips, elbows wrists; new onset headaches; knot to right arm vaccination site and new onset panic disorder.                                            History of Present Illness: This 25 year old reports on June 15, 2004 he received his primary AVA vaccination to the right deltoid.  Within 1-2 weeks he began to itch with no visible cause. He also complained of diffuse joint pain to his shoulders, knees, hips and entire right arm.  He describes the pain as a 3-7/10 depending on activity performed.  The stated his joints ached but would resolve in 1-1 1/2 days without treatment.  He reported a history of a deer tick bite 2001 with no evaluation for lymes dx, Rocky Mountain spotted fever, etc. In October 2004 he sought medical care following injury to his deltoid/back/elbow strain while lifting 5-10 pounds.  He described a shooting pain radiating into his elbow-4-5th digits and dropped object.  He also had his arm "wrenched/twisted" approximately October 6, 2004 by shore patrol.  He reported problems with his arm/fingers began following this altercation.  He has no reoccurrence of joint pain, weakness, or numbness of extremities as of this interview.   He complained of "cluster like" headaches week 2-3 post AVA vaccination lasting "a few minutes to all day."  He described the headaches occurring across his forehead radiating to the back of his neck with "knots" in his shoulders.  Stretching, popping his neck and use of Advil relieved the headaches. They occurred in clusters for a week then resolve for 2-3 weeks before reoccurring.  He denies headaches prior to the AVA vaccinations, fevers, head trauma or illness.  He reported these headaches would trigger onset of hives and itching.  He reported his scratching caused a red raised area (hives) to occur behind his knees, wrists and to his right hip.  He tried Gold-bond powder with some relief; however it returned in a vengeance if medication stopped, worse at night inhibiting his sleep.  After several days of itching and 3 sleepless nights he was sent to medical.  Benadryl was prescribed x 1 for sleep and advised "not to worry about home".  He reports a history of facial-cheeks being chronically red and tender since teens which has gotten worse since Nov 2004.  He reported red circular hives when nervous, stressed, or hot to various locations on his body from head to toe including lip/gum swelling that resolved on own and/or with benadryl use.  In October 2004 he complained of a "knot" at the vaccination site that was tender to touch with numbness and tingling down his arm radiating to the 4th and 5th digits.  He reported his arm being twisted during an altercation in October 2004.   Over the next 5 months (Jul-Nov 04) he would sleep 2-5 hours and was awake 1-3 days at a time due to irregular ship board schedule, itching and stressors (home life-new father).   On November 3, 2004 in desperation to get help for his insomnia and itching he "jumped ship". He jumped because "no one was listening to me, something was wrong (itching, hives, insomnia) so now they would have to listen".  He was flown off ship for psychiatric evaluation and advised he had a "panic disorder with agoraphobia".  There was no diagnosis made concerning his itching and hives as the symptoms were sporadic.  He reports heat, stress, nervousness will trigger the hives.  He describes the rash/hive as a itchy sensation that when scratched turns red, circular, raised lumps that can occur on his hips, wrists, lips, knees, toes, gums and entire body.  His head itched and he was recently diagnosed with seborrhea (shampoo given).  He has been on Benadryl, Claritin then Zyrtec and Zantac for 3 weeks with marked relief of symptoms.  Review of his medical records documents a "pruritic histamine release rash to heat/stress/emotions" with completion of smallpox evaluation form on 25 June 2004. In November 2004 he also reported ringing in his right ear once a month every 1 1/2 months with a recent flight hearing test first normal then failed.  He reported he worked on helicopters and has hearing/visual depth perception deficits.  Advised needs glasses.