Age: 14.0
Sex: F
Vaccine: HPV4
Symptoms: Depression, Fear, Liver function test, Self esteem decreased, Suicidal ideation
Clinical narrative: Information has been received from a physician and a consumer concerning a 14 year old female patient with temporal lobe epilepsy (also reported as mild by the mother) who on 21-JAN-2008 was vaccinated with a first dose of GARDASIL. Concomitant therapy included carbamazepine (CARBATROL). The reporter reported that her daughter developed "irrational thoughts and fears that developed into suicidal thoughts." Her grades in school went down and she developed low self esteem. She also experienced "real bad stomach pain" for a month. She was "sick to her stomach and could not eat". Her weight went from 109 pounds to 96 pounds because she was not eating. She had electroencephalography (EEG), blood work (not specified what test), hepatic function tests (Liver test) and pancreatic test done. No results reported for the tests. The reporter indicated that because of these events her daughter will not complete the GARDASIL series. The patient's outcome reported to be recovering. In follow up telephone call the physician (neurologist) stated that the patient had temporal lobe epilepsy and it could result in the patient being more prone to depression and anxiety. He also indicated that the patient might have received the first and second injection of GARDASIL in the late luteal phase of her menstrual cycle which could have resulted in exacerbating mood changes associated with the menstrual cycle and "epileptiform activity". He stated that it was hard to confirm that GARDASIL exacerbated the patient's condition. Upon internal review suicidal thoughts was determined to be an other important medical event. Additional information has been requested.  5/19/08-records received for neurology consultation visits 2/7/08-Impression:History of epilepsy since 15 months of age with symptoms and MRI findings suggestive of complex partial seizures including some with secondary generalization in early childhood. History of recurrent seizures when off of medications as well as MRI findings of mesiotemporal sclerosis, will require antiseizure medications indefinitely. Had been seizure free for 2 years. In the past few months has increase in anxiety, including occasionally obtrusive anxious thoughts and diminished appetite with weight loss. Expresses worrying about future trouble she might get into. C/O feeling nauseated with early satiety denies abdominal pain or cramping. Current medication:Carbatrol. Visit 3/4/08-Continues to be bothered by anxiety, insomnia and obsessive thought over past 2 weeks after vaccination. Apprehensive about next booster series. Impression: It is possible that these could be manifestations of subtle changes in temporolimbic activity. Also fluctuations might be related to changes in menstrual cycle with some history of irregularity. Anxiety and insomnia may correspond to inadequate luteal phase of menstral cycle. Visit 4/3/08-Less bothered by anxiety, insomnia and obsessive thought but occasionally experiences obtrusive thoughts including suicidal ideation. Additional weight loss since starting Tegretol however weight loss is unusual with Tegretol.