Age: 24.0
Sex: F
Vaccine: HPV4
Symptoms: Neck pain, Nuclear magnetic resonance imaging abnormal, Pain, Pain in extremity, Pain in jaw
Clinical narrative: A few days following my final Gardasil vaccination that received on March, 2, 2007, I had excruciating pain my arm near my elbow. I had to quit my job on March 29 because the pain was too unbearable to continue office tasks like typing. By then, the pain had spread to my neck, and shoulders. On April 3, 2007, I went to see an orthopedist specializing in the arm and hand. He put me on short-term disability and prescribed physical therapy. I went twice a week for approximately 2 months, but the pain kept getting worse. By August, the throbbing, burning pain in my neck was unbearable. On August 24, I saw a neurologist who diagnosed the problem as fibromyalgia. He prescribed Lyrica and Ultram,  but neither drug worked, so I discontinued them. In September of 2007, my general doctor ordered blood tests which all returned normal. I had an MRI done of my neck as well, and it returned normal. The MRI did show, however, that abnormal growths had started to form on my thyroid. By October, I felt anxious, depressed, fatigued, and in extreme pain throughout my upper body. By November, my skin became very dry and my hair started falling out. I tried physical therapy one more time, twice a week for three weeks, but again it didn't work. In December of 2007, I was sleeping roughly 11 hours a night. My dentist prescribed me a night guard, because my neck and jaw pain had caused me to begin grinding my teeth. In January of 2008, all of my symptoms continued. By this time my entire body ached. On January 21, I went to an ophthalmologist, because my eyes had become so dry and itchy. He diagnosed the problem as blepharitis, similar to the dry skin I had developed. Because my vision had become blurry, for the first time in my life I was prescribed glasses. On February 15, 2008, I saw a rheumatologist who conducted extensive blood tests and an MRI of the brain. I had become very confused and foggy headed. However these tests came back normal. He prescribed Doxepin, in order to help me gain better sleep. On June 16, 2008 I was rushed to the emergency room with extreme kidney pain. The doctors found that I had a kidney infection and prescribed me antibiotics. After a week, the infection had not disappeared. My general doctor prescribed me another round of antibiotics. Today, on July 10, 2008, I am still not better. I have pain all over my body, I am unable to type (right now I'm using voice-activated software) or write with my right hand, I feel confused and foggy headed often, I cannot sleep well, my vision is often blurry, my skin is dry, my hair is falling out, and the pain in my kidneys continues.  8/5/08 Reviewed GYN office notes & vax records.  Vax records reveal patient received: HPV #1, 0696F, 8/10/2006; HPV #2, 0955F, 10/30/2006; and HPV #3, 0186U, 3/2/2007.  8/12/08 Reviewed ER medical records of 6/16/2008. FINAL DX: UTI; flank pain; full appearing cervix on CAT scan. Records reveal patient experienced flank pain, chills, dysuria & urinary frequency, nausea & generalized aches x 1 day.  Tx w/meds & referred to PCP & GYN for further evaluation.  8/26/08 Reviewed PCP medical records of 8/22/2007-7/10/2008. FINAL DX: probable fibromyalgia Records reveal patient experienced pain, burning, tingling, stiffness, dyesthesias in arms & neck x 6 mos.  Had been seen by neuro & had cortisone injection in neck for trigger points.  Developed itchy red rash behind right ear.  Neuro consult reveals episodic wrist, hand & elbow pain; pain & tightness in neck & shoulders; difficulty sleeping due to pain; ADLs limited due to pain.  Tx w/meds.  8/5/08 Reviewed GYN office notes & vax records.  Vax records reveal patient received: HPV #1, 0696F, 8/10/2006; HPV #2, 0955F, 10/30/2006; and HPV #3, 0186U, 3/2/2007.  8/12/08 Reviewed ER medical records of 6/16/2008. FINAL DX: UTI; flank pain; full appearing cervix on CAT scan. Records reveal patient experienced flank pain, chills, dysuria & urinary frequency, nausea & generalized aches x 1 day.  Tx w/meds & referred to PCP & GYN for further evaluation.  1/26/2010 Follow-up: Fibromyalgia, muscle pain, fatigue, blurred vision, skin irritation, thyroid imbalance, bladder/kidney pain, difficulty sleeping.