CC:  After receiving 3 anthrax vaccinations 1999-2000, she has persistent joint/muscular pain to bilateral elbows, knee and entire spinal column with occasional headaches. History of Present Illness:    Immunization: Anthrax Vaccine Date: 3/18/1999, 4/1/99, 7/15/99, 1/6/2000 Onset date:   Symptoms: This 28 year old patient began receiving her Anthrax vaccination series 18 March 1999. Following her first vaccination her spine, bilateral elbows and knees began to hurt - 6-7/10 pain scale.  For the next week she stated she was unable to sleep on her back due to pain and her knees and elbows hurt to touch and with bending.  After a few days, she advised HMI ????? of her symptoms and was told she was "okay" (no records available). No medications were taken at this time. She reports a history of lower back and tailbone pain following a fall in 1996. By the end of week two her pain had dulled to a 3/10 and she was given her second Anthrax vaccination 01 April 1999.  Her previous symptoms of knee, elbow and lower back/spinal pain exacerbated to a 9/10 pain scale with "trigger points" bilaterally and new onset of dull sternal pain. Follow up with medical again advised her she was "okay" (no records available).  This pain lasted for the next two weeks. On 15 July 1999 she received her third anthrax vaccination without resolution of above symptom and persistence of pain to bilateral knees, elbows and spine for the next six plus months. Intermittent use of Tylenol and/or Motrin for pain was unsuccessful. In 2001 she stated her back remained "sore" but not as tender as in 1999. She reports two full term pregnancies from 2001-2003 associating myalgia/arthralgia with the pregnancies. As of 2005 she described her pain as a persistent dull ache with a pinching sensation to her back/neck when turning her neck laterally, bending or with flexion/extension that radiates down her spine. She describes the pain as if someone had "hit her funny bone with soreness causing tingling with pain in the left knee worse than the right." She has not sought any further medical care for these discomforts since 1999 as medical providers said she was okay. Concurrently she complained of throbbing headaches three times a week radiating from her temples to the back of her head.  She denies having headaches prior to receiving any Anthrax vaccinations. These headaches lasted one to several hours from 10-3/10 pain scale with blurry vision and inability to sleep beginning in 2003. She described the blurry vision as a "cloudiness or looking thru mist" worse with distance. She denied nausea, vomiting, dizziness, diet changes, drinking wine or taking in large amounts caffeine and no correlation with her menstrual cycles. Exam by  Optometry diagnosed her with myopia right eye (-0.25-0.50x075) with hypermetropia left eye (+0.50 sph) and astigmatism-lenticular. She was given glasses in 2004 that intensified the headaches and visual disturbances.  Naprosyn or Motrin was utilized and helped all of her pains (headaches and joint pains). She admits to feeling "lumps" to the back of her throat with biweekly heartburn described as a "burning sensation" worse with an empty stomach lasting a few hours in 2003 associated with her pregnancy in 2003. Positional changes and food cause no change in this discomfort, it resolves on its own with 2-3 hours. In May 2004 she was diagnosed with pelvic inflammatory disease, candidiasis infection and peptic ulcer disease. Her "heartburn" occurs approximately twice a week since 2003 pregnancy. She describes this as a burning sensation lasting for a few hours with or without food at any time of day/night that resolves spontaneously. By October 2004 she began to complain of a squeezing sensation about her heart exacerbated when running 2-3 miles.  She describes this pain as a sudden sharp squeezing pain that causes her to hold her breath making her dizzy.  This sensation lasts for 30 seconds to 5 minutes occurring several times per episode once a month for the past year that resolved on its own with rest. She denies any neck pain, nausea, vomiting, breathing problems or radiating pain, smoking, dietary triggers.  She reports her mother has heart problems with syncope. A full cardiology exam was performed including an exercise stress test in 2004.  All results were normal (see below 11/15/2004).  As of 2005, this "squeeze" and "heartburn" continues and she just tolerates the discomfort as her physicians have told her she is fine (history PUD and use of NSAIDs needs further investigation).