Age: 39.0
Sex: M
Vaccine: ANTH, SMALL, ANTH
Symptoms: Thrombosis, Vaccine positive rechallenge
Clinical narrative: This is 39 year-old male who was in his usual health until 17 June 2003. He received his primary anthrax, primary smallpox and PPD on 14 March 2003 after completing a briefing and physical exams. He also received his primary smallpox vaccination at that time. States that when he received the anthrax it was given via "a little gray box that they held up to our arm". He had some initial burning at the injection site, which resolved shortly. The client states that he had "whole body swelling, worse in my vaccinated arm".  He cannot remember exactly when the swelling started, but feels it was relatively soon after. The day he received his vaccination, he had mandatory PT for 45 minutes.  About 3-4 days later, he began to notice that his left leg was swollen. The physician assigned to the clients group, pointed this out. He states that the leg did not hurt, but did stay swollen. It would "go down a little if I kept it raised, but not to normal".  He received his second anthrax on 31 March 2003. He again developed whole body swelling, with increase swelling in his left leg. He was deployed on ~ 02 April 2003. He traveled by airplane approximately 27  hours. Upon check in, the doctor took note of the leg swelling, but stated that he should let them know if it began to hurt. He was started on one aspirin per day. He was sent to see a general surgeon on 12 May 2003. He had an ultrasound done, which didn't reveal anything. He was then referred the client to have a venogram done at a civilian medical center. He was unsure of what the Spanish physician was telling him because there was no translator available. The results did not reach the client for several weeks.   The client was sent back for scheduled demobilization on ~ 18 June4 2003. Again he traveled approximately 27 hours by airplane. On 19 June 2003, he was sent to the Emergency Department.  An internal medicine physician that was waiting for him, met him. He had an ultrasound done which revealed a DVT. He was started on coumadin 5mg q d and lovenox BID. He was never hospitalized. He remained on active duty until 17 July 2003. He was monitored at the coumadin clinic. He was taken off the lovenox approximately 12 days after initiation.  Upon demobilization he was sent home. It should be noted that he was discontinued from the lovenox, demobilized and sent home all in the same day. There was no documentation in his medical record that he had a DVT, only that he was being treated for one.  Since returning to home, and being demobilized, he was referred to a doctor. She did a CT of the chest because he had experienced some difficulty in breathing. This occurred approximately two weeks after he first saw her. She referred him to a vascular surgeon, for further evaluation.    The client saw the vascular surgeon on 28 July 2003. He ordered a Doppler study on the clients left leg, which revealed an incomplete blockage in the popiteal area. He prescribed Jobes stockings, 20-30mm Hg, for his left leg. He had difficulty finding the stocking and difficulty with insurance coverage. He was able to get them about 1 month after they were ordered. He is still wearing the Jobes stockings.  His coumadin was discontinued on 21 January 2004.  The client moved in September and reported 01 Oct 2003. In review of his records, a Letter of Eligibility was found that stated that the client should have remained on active duty for an additional 6-months, which would have been December 2003. His was granted a continuation in December of 2003 that stated, "continue drilling status".  He continues to have swelling in his left leg when he is up on his leg for extended periods.  The client has had a difficult time getting work because he has to be off for doctors' appointments. He has not been able to get a job since he arrived last September. His relationship with his significant other is suffering because he "cannot do the things we used to do" and he has required so much attention for the last 7 months. He is constantly reminded of the blood clot at least three times a day when he has to take the Jobes stocking on and off and when he has to take his medication.