CC:  Concerned about onset of migraine headaches, muscle and joint pains, fatigue, rashes, depression, problems sleeping, and tingling to extremities since receiving anthrax series from 1998-1999.                                            IMMUNIZATION  Vaccine Date Onset Date  SYMPTOMS Anthrax  August 28, 1998 August 29, 1998 Complained of muscle aches, joint pain, flushing and redness to her neck and face, and overall pruritis within 24 hours post vaccination.  Within the next 1-2 days she complained of diarrhea lasting for 1-2 days and onset of migraine headaches that persist with this interview. Anthrax #2 September 12, 1998  Same symptoms but with increasing intensity and duration.  Now extremely fatigued with chronic headaches and muscle pain. Anthrax #3 September 26, 1998   Anthrax #4 24 March 1999   Anthrax #5 26 October 1999    History of Present Illness:    This 48 year-old began her anthrax series on 21 August 1998.  Within 24 hours she reported feeling flushed as if "sunburned and jalapeno juice was going up my neck into my head" with generalized itching for several hours. After this sensation eased she complained of a "migraine headache".  She reported the headache began with an aura of oval starbursts with light and noise sensitivity lasting 20-30 minutes.  She also complained of nausea with a lack of appetite, diarrhea (more than 4 times a day), muscle aches, joint pain, and fatigue that lasted for 2-3 days. She sought medical attention and was treated with promethazine and Imitrex.  She does not recall any fevers.  She reports each sequential vaccination prolonged and intensified her symptoms.  She reports her headaches occur 2-3 times a month for the last 4-5 years which have decreased in frequency to once a month.  Her auras last from 15-25 minutes then resolved with the onset of a 10/10 headache that eases to 6/10 with the use of Imitrex.  She has associated nausea and neck pain that eases with the use of heat/ice to the top of her head. As of this interview (November 19, 2004), she has not had a migraine headache for two months.  Over the next few years (1999-2001) she reports uncontrollable crying, lack of energy, decreased activity, isolating herself from others, sleeping a lot and withdrawing into herself.  She was diagnosed with depression in 1999.  She was eventually placed on Paxil in 2001 with relief of these symptoms.  She concurrently complained of difficulty with tingling in her hands and feet while experiencing diffuse muscle aches and severe joint pain to her wrists, arms, shoulders and hips as if she had completed a vigorous workout.  Her physical exercise consisted of a 30 minute walk 3-5 times a week.  Motrin intermittently eases this discomfort as of November 2004. Upon her discharge in 2001, she had been diagnosed with bilateral carpal tunnel syndrome.   She also reported excessive fatigue.  She states since 1999, she would hide from others to take naps at her desk due to excessive fatigue, even if she had slept 12-14 hours the night before.  She reports falling asleep at stop lights and at any time of the day. She reported she would sleep soundly at night but awaken fatigued and "never refreshed".  "I felt like a zombie".  She began to try multivitamins and B50 tablets which have helped with her energy and began a weight reduction diet with Weight Watchers.  She reports having a sleep apnea study done in 2001 and was diagnosed with Restless leg syndrome.  She reports being evaluated for inability to breathe after walking up stairs or attempting to do perform any type of mild activity, weight gain, hair loss, difficulty in handling heat, palpitations, diaphoresis, hot flashes and excessive fatigue prior to her discharge in 2001.  She would become diaphoretic and require 10-15 minutes sitting down for the shortness of breath to resolve.  She denies any chest pain but was placed on a holter monitor.  It captured intermittent rate changes of 105-160 beats per minute.  She was diagnosed with PSVT and mild asthma and was placed on Atenolol 25 mg/day with Albuterol inhaler.  She also reports being diagnosed with Gastroesophageal Reflux Disease (GERD) and placed on Prevacid; a diagnosis of Hypothyroidism that was treated with a low dose of Synthroid; and diverticulitis with colitis in 2002.    Laboratory and diagnostic studies from 1999-2002 are unavailable.