Left foot joint pain starting 10 d post Anthrax #2 and lasting one month. Follow up 03/01/05: An initial VAERS report was filed on this patient in June 2002 for left foot pain follwing his second anthrax vaccine. The patient continued the anthrax vaccine series, and had recurrence of joint pain with subsequent vaccines in 2003. A VAERS update was filed in Septembert 2004. Current patient is asymptomatic except for occosional flares of his right wrist pain which has occurred "on and off", for the past year. He denies joint pain in his feet or shoulders. He has not received additional anthrax vaccines since October 2003, and will continue to be exempt from receiving anthrax vaccines throught March 2006. History of present illness: Patient with history of left great toe pain, left foot pain with onset approximately 10 days following anthrax vaccine #2 and lasting approimately 1 month. Approximately 2 weeks following anthrax vaccine #2 patient experienced left wrist and should pain, be he had experienced chronic shoulder pain since the 1990's (diagnosed as clacific tendonitis); he had als previousl experienced left wrist pain, whiche he attributed to increaced wrist movement with golfing. Patient continued with the anthrax vaccine series. About 1 week after receiving anthrax vaccine #3, patient experienced bilateral shoulder pain and noted the return of his left foot pain. The should pain persisted, but decreased after 1 month; the foot pain resolved within 1 week. Within 7-10 days after receipt of anthrax vaccine #4, patient experienced an increase in intensity of bilateral shoulder pain, and new onset right wrist pain and upper arm myalgias. The wrist pain and myalgias resolved, but the shoulder pain persisted; patient self treated with NSAIDs, but eventually sought evaluation and treatment by his Flight Surgeon and by a Rheumatologist. Currently, patient denies joint pain of his feet or shoulders. He reports intermittent flares of his right wrist pain over the past year; with his flares, he self treats with NSAIDs with adequate pain control; he has not required additional Rhematological evaluation. His pain has not lmited his performance of duties, except he is not able to perfom push ups due to pain during flares. Rheumatologist visit March 2004: 47 year old mail with history polyarthralgias and polymyalgias with temporal assocation following anthrax vaccinations. It is quite possible that these manifestations did occur as a result of th receipt of such vaccinations, but at presents these are clearly resolved. Throughout this history, he did not experience any definite joint swelling to be noted. By history also, he has had chronic bilateral shoulder pains since 1990 ath that time even requiring the excision of calcific deposits from both shoulders by an orthopedic surgeon. He has also had joint pains involving his wrist, als related to his recreation at golf, improved with the use of OTC NSAIDs. He has just gotten coritcosteroid infiltrations into the shoulder and this has resulted in resolution of any shoulder pains at this time. He will just continue the current Physical therapy exercises as scheduled. I will see him for some report serologies to check for any evidenc of serological antibodies that may suggest an inflammatory arthritis. I advised him, should there be any acute joint swelling, I would like to see him as soon as possible. Assessment: Polyarthralgias, temporally assicated with anthrax vaccinations (reproducible) Exacerbation of existing arthralgias, Temporally assocated with anthrax vaccine.