Within 20 seconds post AVA vaccination he experienced severe burning to the AVA vaccine site as if "hit by a bee" that resolved to a sore arm (3-5/10) about 15 minutes later. However, bystanders noted his complexion went white. He sat down and was monitored for 15 min until complexion was normal. He denied any dizziness, nausea, visual changes, chest pain, difficulty breathing, or any paresthesia. Approximately one hour later driving home, he began to feel achy, sick with generalized joint and body aches, headache, and his throat was sore. He had "swollen neck lymph nodes bilaterally". That evening (<12 hours post vaccinations) he developed a fever 100.5 F with increased malaise, body aches, muscle weakness, and nausea (no vomiting). He slept fitfully awakening about midnight with difficulty breathing (inspiration), a sore throat, and the sensation of his throat closing. He reported his "uvula was red and swollen". He was evaluated 06 Oct 2008 am by his PCP Dr. who noted 2+ uvula swelling. Weight was 212 lbs and temperature 98.6 F. He was prescribed CLARITIN, BENADRYL, and MEDROL dose pack for presumed "allergic reaction". Follow up evaluation 3-4 hours later (06 Oct 2008) documented continued complaints of a sore throat (but better) without difficulty breathing, "fever 100.5 F", body-joint aches, severe muscle weakness, and axillary lymph node tenderness. His exam documented: temperature 98.1F, weight 213.2 lbs; a deviated septum; hyperemic; mildly edematous uvula, normal tongue with cobblestone appearing pharynx; AVA vaccine site mildly hyperemic with dressing to SPV site and normal hep B vaccine site; left axilla was mild-moderately tender to palpation without swelling/nodules; otherwise exam was normal. Neuro and musculoskeletal exams were intact with normal reflexes and without weakness. He was diagnosed with "axillary lymphadenopathy and allergic reaction to anthrax vaccine". No further AVA vaccine was recommended. Over the next week (Oct 6-12) he was unable to work. He complained of increasing weight gain ("201?218" lbs), bilateral shoulder, arm, hip, knee pain, body aches, localized red skin, fatigue, headache, and lymph node swelling (left groin, axillary, anterior cervical). He described his joint pain as a dull aching throb with stiffness that worsened with activity. Headaches were a dull tension starting in his neck radiating up over head to eyes (2-3/10). He self treated with ALEVE or TYLENOL with variable relief. He had intermittent red spots to posterior arms, neck, scalp line, back, hips that were nonpruritic, elicited a burning sensation, and were warm to touch. These red spots would come and go (duration hours-days) and were typically present when his joints hurt (but not always) and were not over the joints. He also complained of difficulty sleeping due to physical discomfort. He was eating less, had good fluid intake, and had loose stools 1-3/days (not diarrhea) with left lower abdominal pain. He was seen on 12 Oct 2008. Providers documented BP 138/100, T 98.5 HR 74 RR 18 WT 218 lbs (99.2 kg). There was a 4 cm node to left axilla and bilateral small lymphadenopathy to inguinal area. Thyroid was mildly enlarged. Labs included elev TSH 4.87 (0.27-4.20) otherwise normal ESR, FT4, CBC w/diff, GFR, CKMB, and SMA-7. Treatment included IV TORADOL with minimal relief. He was diagnosed with malaise, vaccine adverse event and lymphadenopathy. By week 3 post vaccination he felt almost normal noting a gradual improvement of symptoms. All symptoms continue to wax and wane in @ a 30 day cycle as of 2010. Evaluations continue into into 4/2010.