51 y/o, right-handed, male, referred to agency for Vaccine Causality Assessment by dr (Neuro-Rehab-BH). Detailed intake interview initiated by agency on 30JAN14. The patient was the Informant and a reliable historian. The pt endorses the onset of multiple health issues after receipt of AVA #4 in LUE (?) at the 67th ER while at work on 17JUN04 (Emergent BioDefense Operations Lansing, DryVax Lot # FAV083). He denies any viral or GI illness in the 30 days preceding his receipt of AVA #4. He did not receive any other vaccines on the same day or w/in 30 days before or after his receipt of AVA #4 on 17JUN04. He denies a prior h/o of adverse events following immunization (AEFI's) or specifically a/w earlier doses of AVA #1 (02DEC03): AVA #2 (18DEC03); or AVA #3 (12JAN04) - Emergent Biodefense Operations Lansing, DryVax Lot # FAV079. Pt denies any local reaction (redness, warmth, edema, itching) at the injection site(s) in the 1st 24-72 hrs s/p receipt of AVA's #1- #4. He denies facial swelling, lip swelling, difficulty swallowing or wheezing during the first 15 min to 3 hrs s/p receipt of AVA's #1 - #4. However, after AVA #4 on 17JUN04, he endorses immediately feeling like someone had slapped him in the face and an incredible burning pain, about '6-7'/10 starting at the back of his head and radiating from his occiput to the periorbital area of his face, frontal/bilaterally in a band across his forehead, eyes and temples, bilaterally. He describes the pain like very intense needlepricks or pinpricks. He got a little sweaty and warm, but denies LOC, N or V. He has experienced vaso-vagal sx w/ venopuncture for a contrast study at Neuro-Opth Clinic (2007), but denies any anaphylaxis w/IV dyes. They made him lie down immediately after receipt of AVA #4 and observed his sx at the ER. He was released w/o limitations. His sx began to recur about once a month after his receipt of AVA #4 w/ no identified triggers, no predictable pattern, onset was usually mid-morning, could be sitting up or lying down. In addition to the intense burning pain and needlepricks radiating from the back to the top of his head and across his forehead, eyes and temples, bilaterally, his sx were accompanied by an immediate left-sided weakness/numbness in his left arm, hand and leg. Once, at the end of Dec'04, he stood up to give a brief and he felt like his Lt leg was 'gone/paralyzed' and he fell over. These episodes continued the rest of his work up to till April of 2005, when his sx subsided for several months. He was seen at the 67th ER about 3 times during his employment for similar sx. His BP was elevated on at least one occasion to 145/95. He does not remember having any diagnostics or receiving any Rx, other than observation of his sx while in theatre. They though he might have Carpal Tunnel Syndrome (CTS) in his Lt wrist. His sx subsided from about April 2005 till Saturday, 17SEP05. He was at work when the intense burning / pinpricks recurred again after several months, starting at the back of his head, all the way to the top of his head and across his forehead, eyes and temples, bilat. This time, in addition to all the other sx described, he experienced loss of vision bilaterally and thought he was having a stroke. His peripheral vision went almost completely dark. He still had central vision, but it was blurry. He endorses +photo/phono- phobia, followed by onset of visual aura, for the first time, w/ bright, gold flashing lights. His visual disturbances were not accompanied by a severe HA, N, or V.