Patient is a 30 year old female who received her first anthrax vaccine (AVA) on 06 Jun 03. She stated that she initially felt fine, and then 2 weeks later she began to notice that she was feeling tired and requiring daily naps. She was deployed during this time and would sleep 12 hours per day. She stated that this tired feeling lasted a total of 5-6 weeks. She also reported that approx 3 wks after AVA #1 and upon return to home that she began experiencing headaches. She described these headaches as a constant pressure behind her eyes and rated it # 5 on scale of 1-10 with 10 being worse. She stated that the headaches would occur every day to every other day and would last approx 2-6 hrs. She would use Aspirin occasionally with slight relief. She denied any changes in vision, nausea, emesis, or altered sensation. She stated that the headaches lasted for a total of 4 wks and that she was back to her normal self before AVA # 2.    AVA #2 on 14 Aug 03: Initially had no problems. Then 2 wks later, she developed a dizzy spell described as feeling of tipping to the right. She denied any spinning sensation. She reported that each episode would last approx 10 seconds and would occur approx 3 times weekly. These episodes persisted for a period of 2 wks. She stated that they were not associated with any activity or position change. She reported no vision problems or altered sensation. She also reported that at the onset of her dizziness that she noticed the reoccurrence of her headaches but no relationship between the dizziness and headaches only that they both persisted for a period of 2 wks and were resolved by mid Sep. She stated that the headaches were identical to those that she experienced following her first anthrax.   She did report one prior period in April of 03 in which she experienced dizziness. This episode was not like the episodes she is now experiencing. She stated in Apr she was in flight training for several hours every other day for one month and that after flying she would be a little dizzy. She had no further dizzy spells since this training ended until Aug 03.  At the end of Sep she began experiencing left ear pain that persisted for about 1 wk and that when the pain resolved she stated that it felt like her thinking was "foggy". She stated it was a feeling that she just had finished a beer. She stated that this foggy feeling would occur 2 times weekly and would start 1-2 hrs upon awakening and would last throughout the day. This foggy feeling persisted intermittently for about 1-2 wks.  She did not experience any further episodes of ear pain.   She also reported that at the beginning of Sep she noticed that she experienced the same tired feeling again and would sleep for 12hrs. She stated that this continued from the beginning of her deployment until she returned home around 20 Oct.  She states that upon returning from deployment that she had a recurrence of her headaches. She stated that this time they were worse with an intensity of # 7, required Aspirin, and were now occurring 4 times wkly.   Now with headaches, she received AVA # 3 on 23 Oct 03. She stated that 2 wks later her headaches ceased, but her dizziness and "fogginess" returned. The dizziness was now occurring 5 times wkly and the foggy feeling was still 3 times wkly. It was at this time that she sought medical attention but did not address the headaches. The dizziness and fogginess persisted until February 04. She denied the return of fatigue. She felt ok in Feb and that everything was gone. She stopped seeing her provider because she thought she was better.   In Mar 04 she deployed. She had no problems, no tiredness and that she felt ok. She returned home in Apr and on 17 Apr, while home, she received AVA #4.   Two weeks following AVA #4, she stated that her dizziness returned, but this time it was different. She said that she no longer experienced the tipping sensation but now had a feeling of impairment and increase fogginess. She stated that it would occur 5 times wkly and that the feeling was more intense, like that of now drinking 3 beers. She stated that she experienced confusion and had problems performing simple tasks. She stated that during conservations she could not remember what was being talked about and experienced difficulty trying to say what was on her mind. She stated that this confusion would only occur when she experienced the foggy feeling.   She reported that in the beginning of Aug, 3 ½ months following AVA #4, her headaches returned. She stated that the pain was behind her eyes and a tingling feeling in the back of her head. She is now photosensitive without any previous photosensitivity. She reported pain for 1-2 wks and a #7 on the pain scale. She stated that the pain would last 3-6 hrs without relief from ibuprofen or ASA.   She also stated that she is feeling a little tired but nothing like her previous episodes. She now requires a nap 2-3 times wkly.  She started seeing her provider again in July and is being worked up with MRI, laboratory studies and consultation services.   Update Feb 05: In a follow-up conservation, she reports that she is still without a diagnosis despite evaluation by ENT, Neurology, and Neur otologist and that diagnostic work up to date is negative.   She states that her dizziness persists and that her cognitive function has decreased. She states she now has a constant drunken feeling and has problems in knowing what to do at times when she approaches a stop sign or a red light.   She reports a reoccurrence of her headaches in Dec after not having headaches since Aug. In Dec, she had headaches from the 1st to 3rd wk then it subsided. A headache reoccurred in the second wk of Jan and continues to persist. She states the pain is a burning feeling behind her forehead and is constant. She reports occasional relief form ibuprofen or ASA. She denies nausea, vomiting, and photosensitivity but reports that at times exposure to noise increases her foggy feeling. She denies any further episodes of ear pain.