Developed atherothrombosis that quickly spread to multiple coronary arteries requiring stents. On 23Dec02 he experienced headache, nausea and dizziness. Patient contacted the Vaccine Healthcare Center for evaluation of his coronary artery disease and the possibility that its onset is associated with the receipt of the anthrax vaccine received in 2002-03. He is a DOD civilian who received the anthrax vaccine as Emergency Essential Personnel. He received no other vaccines simultaneously. The following is an accunt of the sequellae: 18 Dec 02: Anthrax vaccine #1: Experienced no immediate local or systemic reaction, however on 23 Dec 02 he experienced headache, nausea and dizziness. He sought medical care and was given no specific diagnosis or treatment. To the best of his memory all symptoms from above resolved by the time of anthrax #2. 14 Jan 03 Anthrax vaccine #2: On 25 Jan 03 he awakened and was not able to stand due to dizziness, nausea and sweating. He was taken to an urgent care center and was diagnosed with vertigo and labyrinthitis and given Valium and "anti-motion sickness pills.' EKG was unchange. These symptoms have diminished but are still present in mild forms at times. 29 Jan 03 Anthrax vaccine #3: He still had vertigo when he received the immunization and it continues intermittently to this day. No other post vaccine symptoms. On July 6th 2003 he became short of breath when running up a flight of stairs and developed pain across the shoulders. These symptoms subsided with rest. However, the next evening while exercising, he felt his heart "just stop and cramp up like a charley horse." He began coughing and felt palpitations. With an active attempt to relax the symptoms subsided. Over the next 3 days he became increasingly fatigued and on 9 July 03 felt chest pressure and sought medical treatment. Cardiac labs were negative, there were no changes in his EKG however BP was 160/100. The diagnosis of acute coronary syndrome was made and he was admitted to telemetry. Cardiac cath revealed "high grade proximal RCA and mid-LAD lesions. Both were successfully stented and he felt "great for about a month." (1st angioplasty - 1st and 2nd stent- 10 Jul 03). In mid Aug 2003 he began getting short of breath on exertion and feeling fatigued. On 14 Aug 03 he began having chest tigntness. He also was not sleeping well. Angiogram revealed a right posterior descending artery occlusion. It was successfully stented. (2nd angioplasty 3rd stent-15 Aug 03). In Feb 04 he again experienced chest pain in the center/left side of the heart and was evaluated in an emergency room. His CK-MB, troponin, and CPK were within normal limits but his EKG showed "widespread ST elevation consider pericarditis." He also presented with symptoms of sinusitis. He was given an antibiotic and told to take anti-inflammatory drugs. All symptoms resolved within a few days. If he laid on his side or sat up and forward the pain resolved. Intermittently he has this same pain everyday at different levels. He occasionally takes ibuprofen 2-4 tabs for relief of the pain. Two weeks later in March 2004 he again felt pressure and pain across the shoulders. On cardiac cath a high grade stenosis in the body of the left circumflex was found. Another stent was placed. (3rd angioplasty 4th stent-15 Mar 04). In May 2004 he again experienced pressure and pain across the shoulders and right arm. "The doctor decided to stent every suspected diseased artery on my heart that had the slightest indication." Stents were placed in the distal left anterior descending and left circumflex obtuss marginal arteries. (4th angioplasty 5th, 6th and 7th stent - 18 May 04). Patient reports joint pain started with right elbow and generalized muscle soreness around mid 2004. Patient states his docotrs believe this is due to the antilipid drugs. Currently he has this pain in the AM and is intermittently related to position or activity and pressure in right elbow and left knee. He was asymptomatic and active until January 2005 when once again he experienced shortness of breath and shooting pain across the right side of the chest and into the right arm that was relieved by nitroglycerin. He was then diagnosed with 2 more blocked arteries and he had stents in the 1st obtuse marginal and posteriolateral (5th angioplasty 8th and 9th stent - 25 Jan 05). In July 05 he required 3 more stents in the mid to distal left anterior descending artery and the descending 1st diagonal artery and the left anterior descending artery that were 80-90% blocked. (6th angioplasty and 12th stent). A 4th stent will be performed shortley to the (7th angioplasty and 13th stent). He states during this time his BP has been labile and fluctuates from 220/120 and down to 120/75. He also gets palpitations lightheadedness (He states this not the same as the vertigo described above and symptoms are not related to hypoglycemia). Patient is concerned that his progressive cardiac condition may be secondary to the anthrax vaccine since symptoms began after receipt of the vaccine and a cardiac catherization in Jan 95 determined that he did no need stenting. (Patient states he had a catheterization done because he required a pre-surgery physical that showed a possible "clogged artery and damaged heart." However, it was determined that the test was not conclusive, so a catherterization was performed). Cardiac catheterization results Jan 1995: 1. "Hypertrophic, obliterative left ventricle" 2. "30% Mid LAD is the only coronary disease." Currently patient states his providers are baffled regarding the rapid progression of his coronary artery disease. He requests cardiology review for possible association of the anthrax vaccine series and his disease progression, indentification of the possible mechanisms involved and recommendations for treatment to abort this mechanism. Information from 60 day follow-up report states: DOD cardiologists did not feel pt's RAD and multiple stents were the result of AVA. Pt still pursing issue by sending EKG's before the vaccine (normal) and EKG's after the vaccine (abnormal). Medical direction will take case again to cardiac working group. Pt's CAD continues to progress.  1/1/10 follow up - the WRAMC cardiologist CAD was vaccine related. pt did not want to accept this. have not had further contact