Age: 41.0
Sex: F
Vaccine: ANTH
Symptoms: Arthralgia, Ear pain, Fatigue, Headache, Myalgia
Clinical narrative: F/U to initial. Recurrent tinnitus, HA, myalgias, arthralgias and fatigue post each anthrax vaccine. Pt has permanent profile from getting any more anthrax shots. Pt also had local reactions with each shot. tinnutus and otalgia OD, consistent with auricular neuralgia: onset in Jan 1999 after receiving the 2nd dose of anthrax. She was administered a thrid anthrax vaccination 02/06/1999 with a 4th on 06/12/1999. She recevied a 5th anthrax vaccination 12/04/1999. The ringing in her ears, which began after her 2nd vaccination, lasted four months before it resolved. The pain in her right ear, which began after the 2nd vaccination, persisted and finally resolved August 2000. Additional information from 10/29/2002- Continues fatigued with anthrax vaccinations. Please see attached. Symptoms of tinnitus have not returned. Audiogram on 05 Oct 2002 shows slight changes in hearing from last audiogram (29 Nov 01). Due to the tinnitus and ear pain symptoms that occurred with each subsequent dose of anthrax it is not advised that pt received an addition dose of additional vaccine. There is no definate evidence to prove a casual relationship between the anthrax vaccines and the tinnitus and ear pain, however, there is no eveidence to disprove it. We will issue a medical temporary exemption for a period of 12 months at which time we will re-evaluate. The symptoms of fatigued experienced after receipt of the anthrax vaccinations continued and have been exacerbated by stress she encountered with attending nursing school (started one year ago). She has also had difficulty sleeping over this past ear. She is experienced daytime somnolence and decreased motivation to exercise (pt used to be an aerobics instructor). She has ried caffeine to help her stay awake to study, but it makes her symptoms of fatigued worse once it wears off.Her last TSH was reported a "normal" three months ago. We will order a TSH today as well as a CB and ferritin to rule out anemia as cause of fatigue. Pt has also endured a number of stressful interactions with some of her nursing instructors, which may be contributing to her fatigue. We must also consider this stress as a factor in her increasing fatigue. Pt also has new onset headaches for the past two-three months. These headaches are similar in quality to those she experienced acutely with each of her anthrax vaccinations. She feels pain and pressure on the left temple that migraines to the entire head. The pain is not relieved with Tylenol or Motrin. Caffeine will temporary relieve pain for 1-2 hours but pain will then return. These headaches occur daily. Last criminal MRI on 13 Aug 1999 was unremarkable. She recently had an eye exam to rule out vision acuity changes as the source of her headaches that showed no changes in visual acuity and no abnormalities within the eye. The headaches do not interfere with her ability to complete her duties at home, school, or guard drills. Her headaches are not exacerbated by flight during drills. Since the onset of headaches is not associated with guard duty it is not included in her military coverage for medical care. Pt has appointment in Oct. with her primary care physician (civilian) to discuss the new headaches.