Patient received 5th in the anthrax series in 2004. Patient then received a 6th dose in Jan 2025. The injection site is red, hot to touch with hardness of tissue projecting out 2-3 inches from injection site. Approximately the size of a racquetball is the area where inflammation and pain exist. Lifting the arm is possible; however, at 90 degree raised elbow there is soreness. Above 90 degrees pain exists.