Age: 19.0
Sex: F
Vaccine: HPV4
Symptoms: White blood cell count normal
Clinical narrative: Information has been received from a nurse concerning a 19 year old female with asthma, depression and allergic reaction to antibiotics (BIAXIN, erythromycin, ZITHROMAX and Z-PAK) and a history of insomnia, acne, proteinuria and gastritis who on 28-JAN-2009 was vaccinated intramuscularly in the right dorsogluteal with the first dose of GARDASIL (lot number unspecified). On 20-APR-2009, the patient was vaccinated intramuscularly in the left dorsogluteal with the second dose of GARDASIL (lot number 661954/1496X). On 06-AUG-2009 the patient was vaccinated intramuscularly in the right dorsogluteal with the third dose of GARDASIL (lot number unspecified). Concomitant therapy included doxycycline and ORTHO TRI-CYCLEN. On approximately 08-Aug-2009, about 2-3 days after the vaccination of the third dose of GARDASIL, the patient developed burning, numbness and tingling in her feet, fingers and toes. On 12-AUG-2009, the patient was seen in the office. On 12-AUG-2009, complete metabolic profile, plasma thyroid-stimulating hormone test (TSH) and total serum thyroxine test (T4) were performed; folate and B12 were drawn. The results of the tests were not reported. On 12-AUG-2009, the patient was treated with B12 injection and the prescription of LYRICA was written. At the time of the report, the outcome of the patient was not reported. Follow-up information was received from a physician via medical record concerning the patient with insomnia, other acne, proteinuria (unspecified), gastritis/gastroduodenitis, high risk sexual behaviour, vaginosis bacterial, streptococcal sore throat, infectious mononucleosis, acute tonsillitis, irregular menstrual cycle, acute upper respiratory tract infection, acute pharyngitis, vulvovaginitis/vaginitis, dysuria, abdominal pain unknown site, dehydration, other malaise and fatigue, dysmenorrhoea, weight decreased, urinary tract infection, breath shortness, fracture phalanges hand closed - BIAXIN allergy (facial and throat swelling), erythromycin allergy, ZITHROMAX Z-PAK allergy and nickel sensitivity (rash). The patient has a past medical history of asthma (resolved as patient aged). At 14:34 on 06-AUG-2009 the patient was vaccinated intramuscularly in the right dorsogluteal with the third dose of GARDASIL (lot number unspecified). On 12-AUG-2009, the patient returned for evaluation of mood disturbance which has been present several months. She described symptoms of a feeling of anxiety and depression. The symptoms were associated with irritability, episodes of crying and fatigue. The condition had worsened since the last visit. The patient had presented with complaining of tingling. The condition had been presented for a few days. She described the symptoms as burning and tingling. The symptoms were localized primarily to fingers and toes. She started doxycycline Friday and her symptoms began Monday. She stated for 2 to 3 days, her fingers tingled off and on, but when she touched them, they burned, and when she got in the shower they felt like they were on fire. She also stated that her toes tingled all the time and when she put pressure on them like standing, it went away, but when she laid down with no pressure on them was when they burned. Physical examination showed decreased sensation left to wrist, right above wrist. First toe right foot numb with decrease both feet to ankles. The physician didn't think the doxycycline was causing her symptoms. She wanted to complete the treatment. Urine gonorrhea/Chlamydia wasn't run. The physician felt GARDASIL caused her acute peripheral neuropathy. Literature review showed 2 cases of Guillain-Barre. Clinically, did not find any evidence of this disorder since no muscle weakness. The patient was given vitamin B12 injection 1000 MCG, IM. Per the patient her neuropathy symptoms were improving compared to 11-AUG-2009. On 11-AUG-2009, she was burning all over. LYRICA was given for discomfort. She refused antidepressants. On 19-AUG-2009, the patient presented to the office again. The condition had improved since last visit. The tips of toes only hurt when she hits them now. She was not on LYRICA and was still on thiamine. Insect bite left thigh, it itched and was red. Physical examination showed normal sensation leap filament and left thigh with insect bite raised with erythema but no warmth. Vitamin B 12 deficiency anemia was diagnosed. Vitamin B12 injection was given. The patient was placed on thiamine hydrochloride 100 mg, PO, once a day and vitamin B12 1000 mcg, PO, once a day. Doxycycline and LYRICA were stopped. Additional information has been requested.