Age: 18.0
Sex: F
Vaccine: HPV4, HPV4
Symptoms: Pyrexia, Red blood cell sedimentation rate normal, Rheumatoid factor negative
Clinical narrative: Information has been received from a physician concerning an approximately 18 year old female patient with thyroid disease, who on an unspecified date was vaccinated intramuscularly with the second 0.5ml dose of GARDASIL. Concomitant therapy included SYNTHROID. Physician reported that within a couple days of receiving the vaccine the patient called the office back describing arthralgia. The doctor prescribed ibuprofen and said that it was transient. On an unspecified date the patient recovered from arthralgia. The patient sought unspecified medical attention. All telephone attempts to obtain follow up information have been unsuccessful. Follow up information has been received from a physician via medical records concerning an 18 year old female with Hashimoto's thyroiditis since August 2005, scoliosis, nasal allergies since 12-APR-2009, intermittent galactorrhea (about two years ago, on approximately June 2007), non drinker nor tobacco user and no known drug allergies who on 28-JUL-2009 (also reported as 29-JUL-2009) at approximately 4pm, was vaccinated into the left arm with third dose of GARDASIL (lot number 661953/1130X). It was noted that the patient had her routine physical examination on 28-JUL-2009. On 29-JUL-2009, the patient awakened with nausea, aching ankles and fingers, fever to 102 and headache. The patient came to the office on 30-OCT-2009. The chief complaint was a possible reaction to GARDASIL which was given two days ago. The patient experienced nausea and joints hurting for two days and fever up to 102F starting yesterday. She also complained of headache. A physical examination performed on 30-JUL-2009 was normal except for increased joint pain to include all joints and the patient's temperature was 98.7 (oral). The patient never had swelling, redness, etc. The patient did not have redness at the injection site (left arm). The patient had no swollen ankles. The physician's impression included the following diagnosis: arthralgias, fever, splitting headache and probable reaction to GARDASIL. The plan was to observe the patient. The patient's mother wanted the patient to be referred to an immunologist because she thought that the patient's thyroid disease was due to a vaccine. On 03-AUG-2009 a phone call was made to the patient's mother. She reported that the patient's fingers, ankles and knees were still painful (1-4 out of 10, initially it was 10 out of 10). The patient had had pain for 1 week and no fevers or nausea for two days. It was noted that the patient had no had her thyroid labs. On 05-AUG-2009, the following labs were done: TSH 1.17, free thyroxin (negative), Parvovirus IgM (0.2 negative) and IgG 5.9 (due to old Fifth's disease). Prolactin was at 10.9/nL. On 13-AUG-2009, a phone call was made which reported that the patient's arthralgias had completely resolved. The patient was referred to an endocrinologist and was seen on 06-NOV-2009 for evaluation of hyperthyroidism. It was reported that the patient was not having symptoms but was noted to have an enlarged thyroid gland. The patient was found to have a TSH of 112 and FT4 of 0.29. The patient was first placed on levothyroxine sodium 50mcg per day and felt better. About two years ago, the patient started to have galactorrhea most likely secondary to hypothyroidism so levothyroxine was increased to 75mcg per day. The galactorrhea went away and the patient was doing well. It was noted that the patient had a history of problems with vaccinations in the past that have led to joint pain and swelling. This was especially true when she had the GARDASIL. The physical examination was normal. It was reported that an anti-TPO antibody was going to be checked to see if they could determine if the patient had an autoimmune disease that caused her hypothyroidism (could explain her joint pain problems with the vaccine). Additional information has been requested.