Age: 24.0
Sex: F
Vaccine: HPV4
Symptoms: Injection site vesicles, Joint swelling, Musculoskeletal stiffness, Pain, Pruritus
Clinical narrative: Information has been received from a physician concerning a 24 year old female with allergies to tomatoes and pollen, migraine, rhinitis seasonal, deviated septum and band-aids and a history of GERD who was vaccinated with the first and the second dose of GARDASIL July 2007 and October 2008 respectively at her OB/GYN. Concomitant therapy included ADVIL and ORTHO TRI-CYCLEN. The patient developed some reactions a week or 2 after getting the 2nd dose of GARDASIL. The patient experienced swelling of the joints starting from the left knee and then moving to other areas. The patient had stiffness of her hands, angioedema of the lips and generalized urticaria. The joint conditions subsided somewhat and she still had minor stiffness. The welts were still ongoing and itchy. She treated herself with ADVIL as needed, used 1 dose of BENADRYL, and was given an unspecified NSAID. She was just given a new antihistamine, XYZAL on 24-MAR-2009. Around the same time of these events the patient was given an unspecified antibiotics when she had a wisdom tooth removed. Physician was investigating both serum sickness reactions. The patient was seen by a group of physicians throughout the time period of the symptoms. The patient's C reactive protein was slightly elevated. Other labs were pending: CBC panel, latex and food allergies, thyroid, etc. Follow-up information has been received from a consumer who a few days after receiving the second dose of GARDASIL started to experience swelling in her knee, fatigue, and a blister at the injection site. Then she started to develop swelling and pain in other joints which made it difficult to walk. The consumer reported that she saw her primary care physician a few times and thought it may be Lyme disease or lupus, but after a few months of this going on, the patient realized that she received GARDASIL. The patient then saw a rheumatologist in January 2009 and she had blood work done which showed she had elevated C reactive proteins. Around the time she saw the rheumatologist, the patient developed a rash all over her body, and the hives were very painful. Upon internal review, lupus was determined to be other important medical event. Additional information has been requested.  5/1/09 Received Allergy consult of 3/31/09. FINAL DX: chronic urticaria, angioedema & arthritis possibly related to Gardasil Records reveal patient experienced recurrent hives, swelling, stiffness, joint discomfort, difficulty walking since 10/08 & intermittent episodes of angioedema.    5/13/09 PCP records received which include rheumatology consult. Pt initially presented to PCP 12/5/08 with c/o L elbow and bilateral knee swelling, pain, numbness, fatigue and rash.  Referred to rheum. Returned 12/15/08 with c/o rash on stomach and hands, joint pain and swelling of both knees. Assess:  Arthragias with rash.  Rheum consult 1/13/09. PE (+) for painful papular rash, joint swelling of the L ankle and low O2 sats.. Sx suggestive of urticarial vasculitis.  5/26/09 Received rheumatology consult DOS 1/13/09.   FINAL DIAGNOSIS: Urticarial vasculitis with no obvious etiology. Post vaccination knee swelling. Progressed to bilateral pain and swelling of knees wrists and hands with AM stiffness. Painful hives on arms, neck, torso. Lip swelling. Fatigue.