Age: 52.0
Sex: F
Vaccine: ANTH
Symptoms: Arthralgia, Asthenia, Back pain, Discomfort, Disturbance in attention
Clinical narrative: This healthy 54 year old physician assistant is an AD USCG Reservist who reported receiving a total of six anthrax vaccines between 2004 and 2006.  She received her first Anthrax (AVA) vaccine 13 June 2004 with mild flu-like symptoms and fatigue. These symptoms were treated symptomatically with Motrin-Tylenol. Symptoms resolved after one week and she resumed normal ADL.  She received her second AVA vaccination 21 Aug 2004 with similar complaints (HA, body ache, fatigue) which again resolved in one week with OTC medications.  Her third AVA was administered 19 Sept 2004. Within 24 hours she reported swelling to the right deltoid from shoulder to elbow encircling 1/2 her arm. The area was red, tender, and hot to touch. She had difficulty bending her elbow due to swelling, complained of numbness and weakness to her fingertips "as if they were infected". She had difficulty gripping due to pain only. She was advised by medical personnel to use ice packs, motrin, tylenol and return for problems with a diagnosis of "local reaction". Symptoms persisted for 2 weeks before resolving without residual effects.   She reported receiving her 4th AVA 20 March 2005 prior to deploying to Kuwait. She advised medical personnel of the previous reaction and this vaccine was given IM. She complained of mild soreness to the arm, diffuse muscle aches and joint pain, headache, fevers which resolved after one week using Motrin/Tylenol.  Her 5th AVA was administered 24 June 2005 with similar symptoms (site reaction, body and joint aches, headaches).  However she reported in May 2005 while in combat school, she experienced an injury and was diagnosed with lumbar disc herniation. She was being treated with motrin, flexeril, and vicodin.  She could not seperate the back, neck, knee pains from her injury with the increased discomfort felt post vaccination (one month later).  She also began to note increased episodes of irritability. This was described as not tolerating events as she did before...she could not attribute to cause as medication induced, post AVA or due to injury. Her 6th AVA vaccination was administered 22 Jan 2006 with similar local/systemic reactions previously experienced.    She described her headaches as throbbing, pounding sensations to bilateral temporal/frontal regions of skull that was present "all the time". She denied any known triggers, onset, being seasonal, or stress, food, or environmentally triggered. She denied any history head trauma or sinus disorders. She reported her pain averaged 3/10 to 8/10 pain scale at its worst. She took Motrin 600 mg every 6 hours with prn tylenol for these headaches when at their worst.  She drank one cup coffee/day, and rarely drank tea or ate chocolate. She does not smoke or drink. She had lazix surgery in 2003 and denied constant computer use (eye strain). She stated her headaches prior to her first AVA occurred one a month with her mentrual cycles. After the AVA series her headaches increased to 3-4 times/week varing in intensity and duration. Motrin will ease but not entirely eliminate. These headaches will awaken her from sleep but she could return to sleep after 30-40 minutes with medication. Her headaches as of this interview (Mar 2007) remain daily 3/10 pain scale with use of Motrin.   She described her joint pains initially to bilateral knees with lower back pains. She attributed these discomforts to "age and being a runner". She reported running 3-5 miles 4 times a week. This pain worsened following her injury in combat school described as a stabbing, searing pain to the base of her neck, mid and lower back. An MRI diagnosed disc herniation and narrowing spaces with right side sciatica in 2003. She reported having non-specific joint pains to bilateral shoulders, hips, knees which did not affect her elbows, wrists, fingers, ankles or toes. Since her back injury, she experiences numbness and tingling to bilateral arms radiating down medial nerve to her ring/pinky fingers. This discomfort depends on her neck position and lasts 2 minutes to 2 hours. Physicians have suggested epidural injections and/or surgery for related disc problems.   She described her irritability as being easily aggrivated, has mood swings and is less tolerant of events. She complains of difficulty remembering items, what she is doing or where going, and where she placed items.  She attributed this to age and possibly medication induced.   She also experienced episodes of insomnia since 2004 reporting night sweats, irritability, and libido changes. She addressed this with her GYN provider who suggested herbal OTC medications. These only helped her night sweats. She described her sleeping habits as in bed by 10-11 pm and up between 6:30-9 am. She will not sleep initially and has problems getting to sleep. She reported awakening after 2 hours unable to return to sleep for the night. Alternative measures such as reading, drinking warm milk, using sleeping aids, etc were ineffective. She was placed on Ambien in 2004 which resolved her insomnia until January 2007 when the VA hospital changed her to Restoril as it was not in their formulary. Restoril does not help.     As of this interview she reported limited medical care denying any rheumatological or orthopedic evaluations. She is initiating follow up with Haywood VA hospital, Haywood, California as her primary health provider. Her previous medical treatments were with personnel providers working with her at a Kieser facility and physical therapy tips by other friends as she reported she would care for other service member first.  She has seen a chiropracter and reported minimal pain relief.