Age: 20.0
Sex: F
Vaccine: HPV4
Symptoms: Pelvic fluid collection, Serology abnormal, Tenderness
Clinical narrative: Information has been received from a registered nurse concerning her 20 year old daughter with no illness at the time of vaccination who on 22-NOV-2006, 30-JAN-2007 and 10-AUG-2007 was vaccinated with a first, second and third dose of Gardasil (lot# 653735/0688F), (lot# 655165/1425F) and (lot# 658094/0524U) respectively. Concomitant therapy includes atenolol and melatonin. The nurse reported that her daughter was diagnosed with Crohn's disease in November 2007 after receiving three doses of Gardasil vaccine.  The nurse reported that the patient's symptoms began around August 2007.  Medical attention was sought.  No further information was provided.  Additional information has been requested. 3/31/08-records received-11/8/07-evluation of dilated aortic root. Seen in follow-up. Cyanotic color to nail bed but no central cyanosis. Dizzy on occasion when rising from sitting position. 11/31/07-seen for C/O feeling lousy, Crohn's symptoms improving. Episode of bloody stool with abdominal pain, lightheaded, passed out. Dizzy. Viral gastroenteritis symptoms last week. Assessment:Crohn's ileocolitis. 1/7/08- Fatigued, heart racing, palpitations with facial and jaw discomfort. Feeling warm with chills.Assessment: Crohn's ileocolitis with recent flare. Possibly triggered by dairy intake. Additional information was received from medical records from the physician's office. The patient had abdominal pain in the right lower quadrant. The patient's pain on examination is worse in the right lower quadrant and localized better than I suspected based on history. The patient has not had nay symptoms of acute appendicitis. The pain has been fairly chronic. She has had no fevers and the pain wakes and wanes. Because of her long history of menstrual irregularities, as well as heavy menstrual bleeding, the physician is concerned regarding the possibility of cysts or an endometrioses. On 09-OCT-2007 the patient complained of abdominal pain. Overall, the patient noted that she has been having problems for about 3 weeks. The patient cannot define it well. It is usually an achy pain and occasionally sharp. It is occasionally up into the chest area but usually more lower in the abdomen. It is also worse after eating but no particular foods seem to trigger it. The patient noted that she is pretty picky and eats a very bland diet. The patient occasionally was having nausea but has had no vomiting and no diarrhea. The patient has had no real constipation, although she notes she has always had some alteration with bowel movements when some days she has more loose and other days is more constipated but usually goes at least once a day. The patient did not notice some blood in the stool about 1 month ago shortly before these symptoms developed. The patient was not having any perirectal pain or any constipation at that time. The patient's appetite is down overall but is better some days than others. She has not noticed any changes in the skin. No changes in the perirectal tissue. No fistulas or drainage in the perirectal area. No rashes. No mouth sores. No fevers. Energy level has been a bit low but she has just started school and there is no family history of inflammatory bowel disease of autoimmune disease. The patient notes that her periods have been a little bit more frequent but have not been overly heavy. Some cycles are heavier than others. The patient is not currently taking the oral contraceptive pills to regulate her menses. The patient has a past medical history for a positive of enlargement of the aortic root. The patient has no known drug allergies or drug reactions. Family history includes one aunt had rupture of thoracic aorta from cystic medical necrosis earlier in the year and is surviving postoperatively. Father has a thyroid nodule. Paternal grandfather died of colon cancer. The patient is a non-smoker, no drinks or use of any substances. On 09-OCT-2007 the patient's blood pressure was 108/60 mm Hg. The patient had a physical examination. The results were as follows. The patient was awake, alert and in no acute distress. Abdomen was soft. The most tenderness was actually in the right lower quadrant going down toward the pelvic area. There is no guarding. No rebound. Bowel sounds were positive through out. The patient is also mildly tender in the left lower quadrant and is nontender in the upper portion of the abdomen. There are no masses palpated. No hepatosplenomegaly. Lower extremities are without edema. On an unspecified date the patient had a CT of the abdomen and pelvis with contrast. The impression was the examination was very suspicious for Crohn's disease of the distal ileum. Fluid was in the pelvic cul-de-sac may be related to the inflammatory bowel disease. The ovaries showed no masses and contain multiple small follicles. CT scan of the abdomen and pelvis was otherwise unremarkable. On 02-NOV-2007 the patient had a colonoscopy and pathology examination performed. The diagnosis was tissue "A" - ileum terminal biopsy- fragments of small intestinal mucosa with erosion, laceration, exudate, chronic active ileitis, findings consistent with an edge of an ulcer, consistent with Crohn's. Tissue "B" - colon, right, biopsy - focal chronic active colitis with ill-defines granulomas and giant cells: findings most consistent with Crohn's. Tissue "C"- Colon left biopsy- focal chronic active colitis with no crypt architectural distortion, findings consistent with inflammatory bowel disease, Crohn's. At the time of reporting the patient had not recovered. Additional information is not expected.