Pt is a 43 year old male who received anthrax (AVA) # 1 on 25 Nov 03 and AVA # 2 on 17 Dec 03. He reported no problems with both of these shots. On 20 Jan 04 he received AVA # 3 and then at the beginning of Feb he started feeling "changes".   These changes he described as a feeling that he was falling, associated with nausea and dizziness. He would experience these episodes about once per week and it would last approx 20 minutes. Also around this time he experienced headaches at the back of his head and would last a couple of hours. The headache would start suddenly, described as a "sharp unbearable" pain that was initially rated a # 10 on scale of 1-10 with 10 being worse, and then in about 10 minutes the pain would drop down to a  # 4. He would take ibuprofen without relief. He denied vision problems, altered sensation, reported nausea and stated that he never had pain like this before.   The pain changed from a sharp daily headache to a constant pressure in the back of his head at the end of May. This pressure radiates from the back, around to both eyes. He states that this pain is constant and is associated with nausea. He stated he had headaches in the past about once per month but never anything like this.   Also at the end of May he began to notice an aching feeling in all of his joints, which he described as soreness like after working out and with the feeling that he needed to stretch. He stated he would wake up feeling worse and that it involved both his muscles and joints. The pain would eventually ease after moving around. He said that his muscles were tired and would get tired holding up his arms to eat. He said that this would initially occur a couple times per week, and then later on in June it became a constant feeling. He said he remains tired and achy now and did not notice any change in this feeling with his AVA # 4.  AVA # 4 16 Jul 04: The patient reported no changes in his headaches, muscles or joint pain. He does report changes in his vision. He reports that when he is looking at something, on the side he is seeing things. He describes this as "looking at bubbles under the water". He says that as he tries to concentrate on a task it intensifies and then he begins to develop a headache. He states that he has to move an object further away and reports no relief with glasses. He stated that these episodes would only last a few minutes and would occur about 6 times daily. He did have his eyes examined and was given reading glasses but stated there is no improvement with the glasses.    He states that he notices the dizziness mostly when he is tired. He denies the sensation that he or the room is spinning but states it feels like he is on a boat and that sometimes it feels like he is going to pass out.   Follow up conservation on 7 Mar 05: pt reports that he has reported the headaches, vision, muscle pain, dizziness, and joint pain to his physician but he stated they are not addressing the issues. Pt questioned re his low testosterone and he reported that he does not know how long it has been low. He states that his nausea has almost completely resolved but the headaches, joint and muscle pain along with the vision complaints persist.