Patient is a 36-year-old male who developed problems after anthrax vaccine # 6 (AVA) that was administered on 7 Jun 04. He stated that within 3-4 hours he developed a fever and body aches. He stated that all of his muscles were sore as if he just finished a hard workout. He also reported chills and shaking. He stated that he would shake was so hard that it may have contributed to his soreness. He stated that the fever lasted the entire night and he took some Tylenol. The next morning he denied fever, but the soreness continued.  Also 3-4 hours after the immunization he began to experience ringing in his ears. He denied any previous history except for an occasional episode lasting a couple of seconds about once a year after performing the Valsalva maneuver to pop his ears.  He stated that the ringing is in both ears and of equal intensity and frequency. He denies fullness, pressure, problems with balance, recent illness, recent travel, prior ear injury or illness, and denied family history of ear problems. In regards to hearing loss he stated that overall he has not noticed any problems but reported that a recent hearing evaluation revealed a decrease in hearing from his baseline at a certain frequency. He states that the only meds he takes is Lipitor and allergy shots. He stated that the ringing is constant and that there has been no change since the onset. Has sought medical attention and an audiometry has been performed. He said he not taking any medication for his ringing. Patient also reported intermittent numbness and weakness of his hands and feet that would worsen with position change. He stated that he does not specifically recall if it was before or after AVA #5 on 21 Nov 03, but knows it was sometimes last fall. Within one week after AVA #6 he noted increase numbness involving ring and little finger only of both hands equally. One month later around 04 Jul he began noticing sporadic numbness of both feet with rt foot greater than the left. He said this was not associated with any activity. The numbness in his feet would last for one hour and would occur 3-4 times wkly. Now reports that these episodes are decreasing to one every couple of months but hand numbness have persisted and worsened. He reports constant hand numbness since Jun and describes the numbness as not being able to feel quite right. He does have sensation and within the last month has noted a decrease in severity of the numb feeling.  Patient reports joint pain that he noticed within the first week of AVA #6. He stated that he had previous shoulder pain from an exercise in fall of 03 but the intensity increased after the sixth shot. He reported relief of his shoulder pain with physical therapy and ultrasound and currently has occasional pain about once per month after activity. In mid Jun, he also noticed pain in his elbows described as tightness as if someone was driving a spike. Reports pain only with activity and relieved by bracing and physical therapy. He did have a brief episode of elbow pain last summer and diagnosed with possible tennis elbow. Stated this pain resolved before AVA # 5 and had no elbow pain after AVA #5. He stated that he also developed knee pain only with activity, at the beginning of Jul after AVA #6. He stated that this pain lasted 1-2 months, has resolved and now aggravated only by certain activity.