A report was received from a pharmaceutical company who received the report through an enhanced surveillance program conducted by the CDC on 1/5/04 concerning a 54 year old male vaccinee who experienced myocardial infarction on 10/03/03 and heartburn on 10/2/03, which was considered life threatening, required medical intervention and resulted in hospitalization on 10/3/03, after receiving influenza vaccine, Yellow Fever vaccine, Meningococcal vaccine, Smallpox vaccine, hepatitis B vaccine and Hepatitis A on 2/15/03 and Anthrax on 2/3/03, 2/15/03 and 3/5/03. The vaccinee has a medical history of hyperlipidemia, degenerative joint disease and shortness of breath after exercise (baseline for vaccinee). The vaccinee denied any past history of hypertension, angina, congestive heart failure, cerebrovascular accident, valvular heart disease, diabetes, asthma, cancer or thyroid disease. Concomitant medications included Ramipril, Acetylsalicylic acid, Isosorbide mononitrate, Atorvastatin, Metoprolol tartrate and Clipidogrel sulfate (to be clarified). On 10/2/03, the vaccinee experienced heartburn while resting, which he described the sensation as a burning feeling in the middle of his chest and rated it as a six out of ten on a pain scale and he felt a strong urge to burp, but he was unable to do so. The vaccinee was admitted to hospital and seen in the emergency room where he was subsequently diagnosed with a myocardial infarction on 10/3/03. The vaccinees medical records stated that he had experienced intermittent chest pain/pressure at rest for two to three weeks. The vaccinee had elevated cardiac enzymes and an initial ECG revealed ST elevation in lead III and subsequent T wave inversion in leads II, III, and AVF. The vaccinee underwent a cardiac catheterization with stent placement. Mild posterior wall hypokinesis was revealed. The left heart catheterization and left ventriculogram and coronary angiogram revealed severe two-vessel coronary artery disease with the right coronary artery being the cause of the vaccinees recent non-Q myocardial infarction. The vaccinees left anterior descending artery was of a very small caliber, which was not optimal for surgical intervention. He had normal left ventricular systolic function. Gated spectrophotometric images of the heart were obtained following the vaccinees recovery, which revealed that the left ventricular ejection fraction was 66% and wall motion was good. The impression from the Cardiolite Scan was abnormal myocardial perfusion with ischemia in the inferolateral wall region. The vaccinee was discharged from hospital and stated that he did not experience any further chest pain or heartburn type symptoms. The vaccinee was scheduled for another stress test on 11/15/03. the outcome of the event was unknown at the time of the report. A radiological examination was performed on 9/22/03, which showed that the vaccinees lungs were mildly hyper-inflated, but clear of infiltrate. The heart and pulmonary vessels appeared to be of a normal size. The impression was a non-specific hyperinflation and focal degenerative changes of the left distal clavicle of the AC joint. Laboratory tests on 10/3/03 at 08:15 revealed the following: CK-MB high at 11.1u/l, relative index high at 4.8, MB confirmation high at 11.85ng/ml, and CK 231u/l. At 14:54 on 10/3/03, CK-MB Screen relative index 5.2, MB confirmation 19.36ng/ml, CK 330u/l, Troponin I 15.42 ng/ml, monocyte high at 1.2 k/ul, WBC high at 11.2 k/ul, cholesterol high at 255 mg/dl, triglyceride high at 192 mg/dl, LDL-cholesterol high at 199 mg/dl. Bacteriology results were <10,000 CPU/ml, urine was contaminated and 3 or more organisms were isolated. On 10/4/03 at 07:16, Troponin I was critically high at 5.87 ng/ml, CK was 146 u/l, calcium low at 8.9 mg/dl, anion gap low at 9 mmol/l. On 10/5/03, parasitology results were negative for occult blood. On 10/9/03, a chest x-ray revealed mild prominence of infrahilar markings, MCH was 31.8. On 10/10/03 MCH was 31.6. There was insufficient information to determine the reporter's causality assessment, however, the vaccinee stated that he was concerned that the vaccinations he had received may have contributed to his cardiac problems. Follow up pending. (OMIC)