This healthy 54 year-old reports receiving his third Anthrax vaccination on August 7, 2004.  Approximately 1-2 days later, he began to feel "ill" with flu-like symptoms of fatigue, malaise, weakness, fevers, nausea, and a change in appetite.  The next day, August 10, 2004, he was unable to work and noticed swelling to his right forearm extending from the elbow to the hand with "all his joints hurting", especially his right shoulder and left knee.  He reports one morning his right knuckles were swollen where he "could not see any of his knuckles".  He further reports snapping to certain joints (knees and elbows) with some cramping to his neck and arms.    This joint pain was characterized as a 6-7/10 "discomfort" that occurred with extension or forceful flexions while gripping with the right arm/hand with associated feelings of weakness.  As of August 13, 2004 he states he cannot keep his grip with heavy objects and only has "1/2 his strength with a sensation of numbness "high and down back side near the tricep area" of his right arm that extends into his palm and all fingers.    He describes his headaches as a pulling sensation to the back of his head radiating and pulling on his eyes that began about one week ago just before or coinciding with the third anthrax vaccination.  This headache is a constant dull-sharp throbbing ache that began with the second anthrax vaccination and now is worse.  The headache use to last for 1-2 days and would reoccur in one hour to days resolving with Tylenol and Benadryl.  Now the headaches will not resolve with medication as before and there is more photophobia.  He is now awakening with headaches on a 8-9/10 pain scale that dulls to a 3-4/10 over time.  He denies any history of head trauma, MVA, hypertension, migraines, thyroid problems, or recent illness/infections.  He reported to medical on August 16, 2004 for continued feelings of fatigue, headaches, weakness, joint pains, fine scaly red rash like sandpaper on his inner arms, short-term memory concerns, nausea, loss of appetite, increased gas and diarrhea. He states these symptoms appeared "briefly" with the first 2 anthrax immunizations but resolved within a few days; however, this time the symptoms appear to be lasting longer with each vaccination. He denies any recent illness, travel, new food intake, eating fast foods or in restaurants.  He reports a history of Acid reflux, high cholesterol, and joint problems (see ROS). His primary documented his BP at 148/102, pulse 84, and temperature 98.4.  His grip strength was weak on both sides, but symmetrical with DTR's 2+ bilaterally and symmetrical.  He was diagnosed with "reaction to anthrax vaccine" and sent home to rest on Nexium, Vioxx and Lipitor with instructions to follow-up with the clinic on August 19, 2004 if no better.  Anthrax #1 July 11, 2004 Noticed right arm with local redness and swelling to vaccination site with stiffness (4-5/10 scale) to elbow, forearm and hand with problems gripping that spontaneously resolved in 2 weeks.  Also had URI symptoms. Anthrax #2  July 24, 2004 Similar cold like symptoms and reaction to left arm lasting 2-3 weeks with discomfort at a 2-3/10 scale. Noticed intermittent headaches, 3-4/10 scale, that lasted 1-2 days for @ 1 hour resolving with Tylenol and Benadryl. Anthrax #3 August 7, 2004 August 13, 2004: Approximately 5-6 days after receiving 3rd anthrax vaccination felt nauseated with decreased appetite, increased gas and diarrhea, feelings of fevers, increasing headaches, swelling to right forearm and knuckles, joint pain to right upper and left lower extremity, and generalized weakness, fatigue, malaise and flu-like symptoms.