Age: 14.0
Sex: F
Vaccine: HPV4, HPV4, HPV4
Symptoms: No reaction on previous exposure to drug, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Pain, Paralysis
Clinical narrative: Information has been received from a physician concerning a 14 year old female who on 25-JUL-2007 was vaccinated with the first dose of GARDASIL (dose, route and lot # not reported). The patient received the second dose of GARDASIL on 07-FEB-2008 and then received her third dose of GARDASIL on 04-JUN-2009 (dose, route and lot # not reported). The physician reported that on 24-JUN-2009 the patient started to experience painful legs and then on 26-JUN-2009 the patient was unable to walk and by 28-JUN-2009 the patient was walking again. The physician reported that the patient was sent to hospital but it was not specified if the patient was admitted or if she was how long she was in the hospital. At the time of reporting, the patient was recovering. Unable to walk and painful legs were considered to be disabling. Additional information has been requested.  8/31/09 Hospital records received DOS 6/24/09 to 6/28/09. Assessment: Thoracic spine arachnoid cyst without compression of the spinal cord. Lower extremity weakness and pain, cause undetermined.  Patient presented with 1-day history of leg pain which started in her knees, went downward, and then began to ascend to chest, back, and lower trunk. Administered pain medications. Neck stiff, rib tenderness. Nausea after Demerol. Hives and swelling with Fentanyl, codeine and morphine have caused nausea and hypertension. Unable to walk on admission. Abdominal distention. Tender to superficial palpation of abdomen, trunk, and lower extremities. Headache. Adjustment disorder, somatization, generalized anxiety. Much improved and discharged.    10/13/09 ICD9 codes received: 729.89, 729.5, 309.4, 349.2, 493.90, V145, 754.79    10/23/09 Discharge Summary, Medical records, vaccine records and ICD9 Codes received for 06/24-9/26.  Final DX: Thoracic spine arachnoid cyst without compression of spinal cord, Lower extremity weakens and pain, cause undetermined.   Presented in the ED on 6/24 with c/o of lower extremity pain starting at the knees descending, and alternately ascending up to the chest area. In severe pain. Unable to walk. Never requested pain meds.  Did not appear to be in pain.  5/5 strength and 2+ tendon reflexes in ankles. PE positive for mild non-tender abd distension. MRI spine remarkable for arachnoid cyst, no impingement. Lumbar puncture normal.  Behavioral consult revealed adjustment disorder and disturbed emotions, somatization and generalized anxiety. Upon discharge ROM improved. Ambulated with walker.  Discharged to home.  Per the mother's account included in medical records, 6 further episodes occurred intermittently through 9/30, with additional admit in Oct. Mother's account notes more severe pain and paralysis with fleeting blindness L eye. Vision exam normal. Swelling trunk area below ribs. Diaphoresis.  (+) past West Nile Virus exposure, alternately low and high bld sugar, sinus infection, low potassium levels.   ICD9 CODES: 729.1, 300.0, 786.59, 844.9, 078.10, V20.2, 754.70, 682.9, 467.1, 922.1