Patient (pt) is a 54 year old male who received his first anthrax (AVA) on 11 Jan 03. He stated with this shot he had some soreness in his arm for one day only. Later that night his wife noticed that he had red raised bumps across his chest with slight itching. Rash did not resolve. He also noticed one week after the shot that he developed chills, and fever for a couple of days. Thought it was just the flu.  29 Jan 03 he received AVA #2. The pt reports that on this date he inadvertently received 2 doses of the anthrax vaccine due to a mix up in paper work. He reported that later that same day he felt dizzy for about 15 minutes and had nausea, but no emesis. When he arrived home later that pm he noticed that he had developed chills and fever that lasted a couple of days and he again thought it was the flu. He reported that there was no real change in the rash on his chest except that he noticed increased itching and tingling. He reported that after the second shot that he just did not feel like himself. He also reported that 3 wks after the second shot he started to develop headaches. He denied any prior history of headaches and reported only slight relief with BC powder. He stated that the headache would last 2-3 hrs then subside and reoccur 2-3 days later. Headaches have been continuing every 2-3 days since mid Feb 03 to present. He also reported some problems with his vision, regardless of the headache. He stated that his vision became blurry and remains blurry today.  13 Feb 03 he received AVA # 3. Unlike the first 2 injections he denied any fever or chills and denied any changes in the rash on his chest. He did notice a slight increase in his headaches one week after the 3rd shot and that 2-3 wks after this shot he noticed that he developed a rash, similar to that on his chest on both of his arms. This rash consisted of small little bumps without drainage.  20 Feb 03 he received his smallpox vaccine. He said that the area healed without any problems, but later that spring he started seeing dermatology for an outbreak of psoriasis on his knees, scalp, elbows, hands, buttocks and scrotal area. He admits to a prior well-controlled history of psoriasis with scalp lesions only. 29 Jul 03 he received AVA # 4. No changes were noted in the headaches, nor did he experience any fever or chills. He reported that his rash on his chest broke out more and was now developing psoriasis on his face that eventually spread to his legs later that fall. He reported that around Sept of 03 he started noticing problems with his PT tests. He began to experience pain to knees, hips, thighs, and his PT score started to decline. He also noted stiffness and that his fingers were painful. He had equal pain in both knees and ankle. Left hip was more painful than right and his left hand was painful. He stated that both his muscles and joints were painful. He reported that he developed increased pain to his left hand and knees when he missed a step during a dizzy spell. Around this time he reported slight relief with headaches, but has daily pain of muscles and joints. He reports problems with walking and with stationary standing.   12 Jan 04 he received AVA # 5. Within the first couple of days he began to notice an increase in his headaches with pain lasting 6-7 hrs and headache would occur every 1-3 days. Also began to notice increase pain in his joints and thighs. He also stated to notice an increase in his blood pressure and cholesterol. He reported no changes in his rash.  In Feb 04 he developed chest pain and required an emergency room visit. He stated that the pain felt like something shooting through his body with burning upper center pair to his chest with burning to both arms. He denied neck or jaw pain. He did have shortness of breath, diaphoresis and no nausea. He was told he had chest wall pain and that his enzymes were normal. He develops chest pain and shortness of breath almost daily and it is not associated with activity.  His wife also stated that she is noticing problems with his memory described as frequent lapse of short-term memory, periods of confusion, periods of short tempered, problems focusing. He has not had a neuro evaluation.  Pt stated that he is currently under evaluation for a small cyst that was located on his kidney in 1999 and that it is currently getting bigger. Is being followed by nephrology.