Cc:  I had a heart attack 1 day after receiving my 3rd Anthrax Vaccination. This service member is a 43 yo male with a history of hyperlipidemia and family history of premature coronary artery disease who had an Inferior MI (99% occlusion of RCA) with subsequent stent placement.  He is concerned that recent immunizations may have contributed to his MI. IMMUNIZATION          DATE                                  SYMPTOMS Smallpox-primary 3 jabs Hep A #1 Hep B #1 MMR IPV TD Typhoid Anthrax Influenza PPD 14 Oct 03 Received vaccinations on this date.  Reports that he received smallpox and anthrax brochures and briefings.  Did not experience any known adverse reactions to vaccinations.  Reports that his smallpox site was small but healed normally.  He thinks he may have had smallpox in the past but he had no record and no Jennerian scar was visible. Denies any chest pain after the vaccines.  He experienced baseline dyspnea on exertion, which he had been having for months.  He does recall having cold-like symptoms (runny nose) for weeks.  He does not recall a fever.  He states that he had a small, rapidly healing smallpox vaccination site.  No rashes. Anthrax #2 27 Oct 03 No systemic symptoms after Anthrax #2.  He does recall a small lump at the site of the vaccine that has now resolved. Anthrax #3 Hep B #2 01 Dec 03 No problems on the date of the vaccines.  He reports that he received the vaccines that morning, and afterwards he went to the range.  He reports that they were short staffed that day and he did have to load heavy documents and water onto a truck.  However, he did not experience any chest pain while working. He experienced baseline dyspnea on exertion.  He did not PT that day. 02 Dec 03 He awoke at 0130 with pressure on the left side of his chest.  He initially thought it was heartburn but the pressure then got worse.  He took 3 aspirin and tried to sleep.  The pressure increased, and then his left arm and hand started throbbing.  He took an additional 2 aspirin with no relief.  Pain slightly relieved by sitting upright and was worse with lying down.  Someone in his barracks alerted the medic who took him to Emergency Department where he was admitted.  His initial EKG showed borderline ST elevation in the inferior leads, and a second EKG showed probable inferior infarct.  Serial cardiac enzymes were elevated. 12/03/03 Transferred for cardiac catheterization with subsequent stent placement. Discharge summary indicates that during his hospital course, he was managed medically with ASA, Lovenox, beta-blockers, IV nitroglycerin, IV Integrelin, ACE inhibitor, and Zocor.  The patient underwent cardiac catheterization which showed subtotal occlusion of the mid right coronary artery with thrombus.  He was treated with percutaneous transluminal coronary angioplasty and stent of this vessel.  He had residual thrombus in the right ventricular branch which was treated with ReoPro, aspirin, and Plavix.  He was discharged home on 12/06/03. 02/03/04 Presented to Health Care Center.  Reports that overall he is doing well.  He is currently in Med Hold.  He is scheduled for a stress test on 02/04/04 and also has a follow-up appointment with his internal medicine physician that afternoon. He states that he occasionally experiences chest pain that he describes as a sharp shooting pain on the left side of his chest that lasts only a few seconds.  No radiation to arm or neck.  The momentary pain occurs at rest or with exertion.  He also reports that he occasionally notices that he gets lightheaded if he bends over.  The lightheadedness only lasts a few seconds, and he has not had any syncopal episodes.  He reports that his blood pressure has been normal each time he has had it checked.  He reports that his weight is stable, and he denies cough, pedal edema, or fatigue. At this time, he is considered non-deployable. 60 day follow up 04/12/2004 he reports that he is doing well overall, but he continues to have occasional chest pain at rest or with exertion. He had a normal exercise stress test (2/5/04). He is also being evaluated for abnomral chest CT results from 12/03.