Age: 15.0
Sex: F
Vaccine: HPV4
Symptoms: Abdominal pain, Activities of daily living impaired, Computerised tomogram abnormal, Condition aggravated, Conversion disorder
Clinical narrative: Currently 16 years old, did received three GARDASIL shots, the first one being in February 21st of 2008, second being April 24 th of 2008, and the third one being February 19th of t2009. The patient has had some previous with abdominal pain and a headache for which she was seeing Neurology and Gastroenterology. After her GARDASIL shot on February 21, 2008, the patient had an episode February 27th having emotional due to a boyfriend problems, did take a knife and made some small cuts in her wrists. Seen through the emergency room and thought to be stable, sent home and was being followed by a counselor in April of 2008. It was thought that she might benefit from some antidepressant medication and was started on Zoloft 25mg once a day. The patient was seen later, had her Zoloft increased to 50mg once a day. She did receive a second GARDASIL shot on April 24,2008 . The patient continued on the Zoloft for a few months and it was subsequently self-discontinued. For the most part, the patient did well over the ensuing next 12 months until April 23, 2009, when she was in a car accident, for which she had a CT scan of her abdomen, which did not reveal any abnormalities from the car accident, but did reveal ovarian and fallopian tube abnormalities thought to be consistent with pelvic inflammatory disease and was admitted to Hospital for antibiotics and was also seen by GYN. Also noted to have some mild kidney abnormality of uncertain significance. Nephrology just recommended follow up ultrasound. The patient did well for a while, then started having some more abdominal pain with some blood in her stools. She had previously seen Gastroenterology who had planned on giving her endoscopy and colonoscopy. If she had problems, started back on some Mira lax and Prevacid. A follow up appointment with Gastroenterology was scheduled. In the interim, the patient also had a laparoscopy by GYN in May, now waiting for a return visit to Gastroenterology. The patient started having more abdominal problems and dizziness, was admitted to the Hospital for some observation and subsequently discharged. The patient had started having some dizziness and syncopal episodes and was seen at the emergency room for a few times, was seen back in the office and did not have a non-responsive episode on August 31st, need to be transported via squad back to the hospital. Neg head CT scan. The patient was readmitted, evaluated by Neurology and psychiatry and thought to be having a conversation reaction and Neurology did not feel any further work up for seizures or other neurologic conditions was warranted. Wanted to be placed on the psychiatric unit, was there transiently. The mother and patient decided to be discharged , was to have a follow up from the gastroenterologist however, that follow up appointment was not kept. She was not on any intervening follow up by Psychiatry. The patient was not able to attend school due to the no responsive episodes; however, the patient feels that she may be able to re-attend school, but mom has noted that she may be having more of an unusual gait disturbance, which is transient in nature. Mother and the patient feel her problems may be related to the GARDISIL vaccine. 10/16/2009 received hospital records for 4/13-4/16/2009 . Patient in MVA 4/13/2009, main c/o of abdominal pain that patient stated had for 1 month and did not worsen after MVA. PE noted adnexal tenderness with abdominal tenderness, Pelvic exam noted ? PID.TX: IV ABX. DC DX: PID  8/28/2009 records for ED visit. Patient  presents with c/o's abdominal pain, tacchycardia and syncopal episodes.  Pelvic exam + for cervicitis,  PE+ for abd tenderness, + for flank pain and BRB noted per rectal exam.