Age: 23.0
Sex: F
Vaccine: HPV4
Symptoms: Headache, Insomnia, Metabolic function test normal, Myalgia, Stress
Clinical narrative: Patient received first dose of GARDASIL vaccine on 06/12/2008. Per Clinic note: "HLD is a 24-year-old woman who experienced what has been described as a grand mal seizure at about 3 p.m. on 08/21/2008. This was a seizure that was witnessed by a friend and afterwards she was evaluated at the Emergency Room. Patient states that on that day of the seizure, she had been feeling kind of dizzy and out of it all day. She had never experienced that exact feeling before. HLD has been taking XANAX at a dose of 1.5 mg nightly for two or three years for anxiety. The day before the seizure, she had missed her evening dose of XANAX. In addition she had very little, if any, sleep that night before the seizure and she reported feeling also somewhat stressed out on the 08/21/2008. The witness describes the seizure as HLD getting a strange look on her face and gazing around the room randomly for about 30 seconds, after which HLD's eyes rolled back in her head and she fell to the floor and had what were described as flailing movements of her arms and her legs for about 2 to 3 minutes with some turning blue towards the end. Afterwards, she was confused, did not know where she was, or what was going on. In the Emergency Room, she did have a CT scan that showed no evidence of trauma or bleeding or midline shift but that there was an old lacune in the left inferior BG. She had postictal confusion, lasting for a few hours. She did have quite a severe headache and received narcotics in the Emergency Department which may have contributed to some difficulty in clearing of her mentation. She also had muscle soreness for about three days afterwards. During this seizure, she did not bite her tongue. She did not have any bowel or bladder incontinence. At the time of her evaluation in the Emergency Department, the seizure was attributed possibly to withdrawal from XANAX compounded by a sleep deprivation and stress. She has had no further events since the time of her Emergency Department visit. CT scan did not show a cause for seizures but did show possible lacune in the basal ganglia. EEG done 08/21/2008 was within normal limits without evidence of epileptiform activity."  11/24/2008 MR received from PCP for well exam 6/12/08. HPV#1 given. Assessment: Visual Impairment (reports difficulty with night driving), Acrochordon, Nicotine dependence, Normal pelvic exam with cervical PAP smear. PE WNL except skin tags-removed. Started on Chantix for smoking cessation. PMH: Abdominal tenderness, Acute cystitis, Acute Sinusitis, Acute URI, Anxiety, Blurry Vision, Cough, Dysmenorrhea, Female pelvic pain, Focal hyperhidrosis, Gastroenteritis, Tissue injury, abrasion, toe injury, vaginitis, depression. NKDA.  12/10/2008 MR received from neurologist for several visits beginning 9/3/08 in f/u of single episode seizure on 8/21/08. Pt and witness report pt had been felling dizzy and out of it prior to the seizure. Pt had missed pm dose of Xanax. Pt developed a strange look on face, staring, then eyes rolled back, pt fell and arms and legs began flailing x 2-3 minutes with some cyanosis. (+) post-ictal confusion and h/a. (+) muscle soreness after. Impression: Seizure. PCP questions whether seizure, joint pain and fatigue r/t Gardasil. No further seizures noted at 11/26/08 visit.