Patient is a 46 year old male who reported a prior history of muscle and joint pain due to injuries he previously sustained. He received a total of 3 anthrax vaccines from Nov 03-Jan 04. He reported that the muscle and joint pain he was experiencing increased after he received the anthrax vaccination (AVA). After receiving AVA # 1 in Nov 03, he had a worsening of his pain in both knees due to an injury in Oct 03. He noticed this worsening about two days after AVA and in Dec, he fell, injuring his knee. He reported that after AVA #2, he began to notice pain in his hips and after AVA # 3 in Jan 04, all of his joints started hurting to include his ankles, knees, hips, shoulders, and elbows. He also stated that his muscle also are painful and reports occasional swelling of his knees, and wrist. This swelling increases in the am and with activity. He states that the pain continues today. He reports no problems with walking on flat surfaces and that the pain is intermittent in all joints. He stated that over the past two years this pain has worsened but the pain is controlled with medication.   He also noted a rash in Nov 03 that worsened in Dec. He stated that he had jock itch prior to his AVA but after AVA #1 the rash spread to his chest and then to his groin area. He denies rash to his neck, arms, back, or legs. He described this rash as flat little red bumps with itching but the areas on his hips are slightly raised. He denies pustules or vesicles. He went to MD and was given antifungal with little relief. MD thought he had jock itch.  He has no recall of worsening with certain foods or detergents. There is no medical documentation of rash, and no dermatology evaluation. The patient reports that since his fall on his knees he has noted an electric shock feeling in both legs. He notices this approx 3-4 times weekly with each episode lasting 30-45 minutes. He also reports a tingling feeling involving his right and left arm, to fingers and down both legs to his feet and toes. He reports he has greater numbness in his feet and these episodes occur 2-3 times a week and last approx 1-2 minutes. He stated this tingling began after his fall and back injury in spring of 04. He stated his MD told him that this may be due to his back and neck problems and he reports an increase in this tingling feeling.  He also reports noting ringing in his ear. He has prior documentation in 1999 of High Frequency Hearing Loss and in Jan 04 he was also noted to have tinnitus. He stated that he had very rare episodes of tinnitus prior to AVA and now he has episodes that are more frequent. He reports that he may have ringing for a couple of days and may have a couple of days without ringing. Denies any prior history and states it is in both ears with rightt ear greater than left. He reports occasional fullness and no problems with balance. He stated that his hearing loss has worsened since receiving AVA and he denies any illness or travel. He denied any prior history of injury and reported that he has a sister that was born deaf. He currently uses a hearing aid since 2003 and reports that this at times makes the tinnitus worse. He  He is also reporting that since the fall of 04 he had noticed increase fatigue that has started bothering him. He states he only sleeps 3-4 hours due to the pain or at times the tingling. He states he sleeps when he takes his medication because the medication causes drowsiness. His wife reported that he gets tired easily whenever he does something and also he now catches whatever bug is going around, whereas before he would never get sick.  He also reported that in the fall of 04 he began to notice problems with his memory. He states he is told a list of things to do, but that he cannot recall that list. He also stated that at times he has even forgotten to pick his daughter up from school and where he places things. He stated that he has told the doctor of his memory problems but that they did not address it any further nor had any diagnostic evaluation.  Spoke to wife on 9 Jun re memory loss. She states that he has significant impairment of his memory. She stated that when they go to a place that they have been many times before he couldn't remember how to get there. She also stated that he has to write everything down and cannot remember more than 2-3 things, if that. He also reported a decrease in his visual acuity and that it now takes him awhile to focus on an object. He has had eye exams done and was given glasses which help a little but he continues with problems focusing. He reports occasional eye aching but denies any pain or photosensitivity. He reports no double vision or increase tearing.