Age: 18.0
Sex: F
Vaccine: HPV4
Symptoms: Injection site pain, Injection site pruritus, Injection site swelling, Lacrimation increased, Lip swelling
Clinical narrative: Patient had 2nd HPV vaccine on 03/25/08 at her doctors office.  She passed out just a few minutes after having the injection. She immediately started having pain, swelling, itching and redness of her upper left arm and dizziness. Then by 04/01/08 swelling and pain down the entire arm and pain moving into the neck. She is also having joint pain. Went to the doctor on 04/01/08 and was given prednisone (6 days) and diclofenac pot. 50 mg for pain and the doctor advised her not to have the 3rd dose of Gardasil. She started feeling better a few days later.  Then on 04/09/08 she went to the ER because she started swelling in the face, lip and tongue, had difficulty breathing, hoarseness and throat hurting (this started around 4pm and by 7pm breathing became more difficult). Different test were run and blood was drawn but everything was negative. We were told this was happening because of her Gardasil vaccine. We got home from the ER at 2am and the top of her arm was swelling above where blood was drawn.  Whenever the blood was drawn she said this was very painful and its the same type of pain she felt whenever she received the Gardasil injection.   Then on 04/10/08 went back to doctors office because feeling worse - face swollen more, sinus pressure, congestion, nausea, dizziness, hoarseness, throat still feeling very tight and swelling down arms and went to doctors office and was given cefdinir 250mg/5ml, Claritin and naproxen 500mg.  Then on 04/11/08 went back to the doctor because swelling, pain, hoarseness had gotten worse and was now told to stop all medications. The doctor started her on Tagament, Zyrtec and prednisone (6 days) again. By 04/12/08 the swelling is now all over her body and horrible pain all over her body. Over the next week swelling comes and goes.  The pain she is having has gotten no better.  This pain is all over and it hurts to barely touch her skin and taking showers are very, very painful for her.  She has muscle weakness in all extremities and finds it difficult to walk upstairs. She has even had swelling of her right eye with redness, watering, and matted shut on 04/20/08 and 04/21/08.  Today on 04/22/08 around 3:40pm she said she is hurting everywhere but especially in the head and her face is starting to swell again.  She felt like she was running a fever and took ibuprofen.  By 4:40pm she states that the swelling is moving down into the throat area and feels her throat tightening up again.  I spoke with the doctor again at 6:00pm and told him her symptoms and he again is going to give her prednisone and an inhaler for breathing. He's not sure what to do with her and is possibly going to send her to an allergist.  Before this injection she was healthly and not having any of these problems.  Now she keeps wondering how much longer she is going to feel this way.  5/15/2008 MR received from ENT consult dated 5/6/08 with DX: Migratory angioedema in reaction to Gardasil vaccine. Pt refered to ENT for laryngoscopy for c/o hoarseness and dysphonia. (+) swelling of the face and ears with skin sensitivity.  5/16/2008 ER record received for DOS 4/09/2008 with DX: Neck pain.  Pt presented to ER with c/o sore throat and difficulty breathing. Recent immunization with local reaction of swelling. PE WNL. O2 sat 100% RA. D/C home. 5/21/08 MR received from PCP for 3 OVs 04/1, 4/11, 4/18/2008 with DX:  Localized allergic reaction to Gardasil, Angioneurotic Edema, and Myalgia and Myositis.  Intially presented with L arm pain, swelling and tenderness, progressing to swelling of both arms as well as lower lip and tongue. Also developed cold sx at this time. Bilateral arm pain and R lower leg pain by last visit. Tx with steroids, antihistamines and Naproxen as well as Omnicef for cold sx. Allergy and Rhem referrals. 6/17/2008 Rheumatology consult received for DOS 5/1/08 with DX: Myalgias, Arthralgia, Fatigue. Pain in joint. Sleep disturbance.  Angioedema. Intermittent swelling of throat/swallowing difficulty. ? angioedema. Pt reported pain following 1st Gardasil injection x 1 week which resolved. After 2nd Gardasil had L arm pain and swelling, progressing to neck, arms and legs then feet ankles and knees. Fatigued and tired since 3/2008. Not sleeping well. PE (+) for tender points.  08/19/2008 MR received from allergist for DOS 5/13/2008 with Dx: History of angioedema. No probems currently and PE WNL.