Age: 18.0
Sex: F
Vaccine: HPV4
Symptoms: Menorrhagia, Myalgia, Nausea, Nuclear magnetic resonance imaging normal, Odynophagia
Clinical narrative: Information has been received from a nurse concerning a female patient who was vaccinated with a dose of GARDASIL (lot # not provided).  Subsequently the patient experienced chest pain and mild unspecified symptoms.  Additional information has been requested. Follow up information has been received from a physician via medical record which reported that the 18 year old patient with no known drug allergies had a history of teeth removed in August 2006 and some developmental problems. The physician reported that patient like a thin healthy-appearing young lady that dose not use alchol or tobacco. The patient had been complaining of abdominal pain and anemia since last year (2008). She has lost weight. She can not eat. She had nausea, vomiting. The patient claimed that in July of 2008 she had GARDASIL, and following this, she started that there is no definite relationship to this event except temporally. The patient was taking birth control pills (unspecified) for regulation of her heavy menstrual period. She had a little bit of dysmenorrhea. The patient stated that she lost 10 pounds last year but gained it back again. The patient had a multitdude of other symptoms including gastroesophageal reflux, burning with swallowing, dysphagia, pain in her throat when she swallow hot or cold things. other food bother her but she cannot relate what exactly that is. The patient had been seeing a rheumatologist elsewhere for joint and multiple pains and has been diagnosed with possibly some fibromyalgia. She had pain in her right wrist which was x-rayed and had an MRI done and showed nothing. She also complained of burning, stinging and frequency urination. She had not had any fever and all of these symptoms seemed to be unrelated to each other. Since she had not had any fever and all of these symptoms seemed to be unrelated to each other. Since she had been having GERD like symptoms, she had been taking PROTUNIX 40mg once a day which she has not helped any. She takes hormonal contraceptives (unspecified), FLEXERIL 10 mg 3 times a day from her CELERBREX 200 mg twice a day free the rheumatologist without ant relief. The patient weight 104 pounds and heights was 61 inches. Blood pressure measurement 128/62. pulse rate 88 and respiratory rate were 16. The patient was afebrile and at physicial examination the patient complained of chest pain across her anterior chest. There was tenderness but the patient stated that this was mainly related to swallowing. She had a vague joint pain, muscle aches, and nothing else specifieec. Otherwise the patient was normal. Laboratory test performed included: blood hemoglobin test 11.8 (it had been that way for quite some time), white blood cell count normal, urinalysis test showed few bacteria and few white cells with a urine culture negative at 24 and 48 hours. Ultrasound of pelvis didn't show anything else. Ultrasound of gallbladder did show cholelithiasis. The patient said she also had indigestion and discomfort and it bothered her stomach with fatty food, fried foods and hamburgers, chilli pizza, so she had avoided those things. The patient denied ever having like a pain attack, but said that these things caused her to have an upset stomach and bother her. The physician stated how that bother her is not really clear, the patient didn't day she had pain. Hepatobiliary Scan, ejection fraction showed a 56% ejection fraction, but the patient said that bothered her stomach as well as during the Hepatobiliary Iminodiascetic Acid performed (resulting not reported). The patient had an episode of nausea and pain in the right upper quadrant which did subsided after the HIDA scan was completed. The patient was seen on 19-JAN-2009 and the abdominal examinations was fairly normal, however her white blood cell count was normal, urine cultures were negative and when reexamined on 26-JAN-2009 the patient calls that after HIDA scan, half way through when she had when she had the injection of cholecystokinin, she had the same symptoms she has when she is eating spicy foods of hamburger or chilli. Gallstones was confirmed an ultrasound. Nothing else was seen in computed axial tomography (CAT scan). No other pathology had been identified by physician. The physician impression the abdominal complaints muscle pain, aching joints, back ache, which were not probably related to gall stones. The patient was set up for an Esophagogastroduodenoscopy (EGD) to evaluate her GERD symptoms and a daparoscopic cholecystectomy. 20-JAN-2009 the patient was seeing by another physician who reported that a computed axial tomography (CAT scan) an her abdomen and pelvis and pelvis and transvaginal and abdominal ultrasound were all done as well scan ultrasound for her gallblader, all of which so far had not shown any pathology, specifically, the ultrasound showed an 1.2. cm right ovarian cyst. Only a trace of cul-de-sac-fluid, most likely physiologic. The physician reported normal blood flow to both ovaries, some small follicles seen in the left ovary. Uterus and endometrium looked normal. By ultrasound she did have some shadowing with positive gallstones in her gallbladder but no Murphy signs, no wall thickening, no pericholecystic fluid. All of her pain is the lower right quadrant and lower left quadrent. An HIDA scan will be obtained, CTA and HGD scan are pending. The physician reported that the cholecystitis and cholellthiasis did not appear to be symptomatic at the time of the report. The physician stated that all of her symptoms seemed to be vague and diffuse on other areas of her abdomen and other parts of her body. At the time of the report the outcome is unknown. No further information is available.