Age: 14.0
Sex: F
Vaccine: HPV4, HPV4, HPVX, HPV4
Symptoms: Muscular weakness, Nausea, Nuclear magnetic resonance imaging normal, Oropharyngeal pain, Parosmia
Clinical narrative: Initial and follow-up information was received from a physician and a cardiac surgeon concerning his 15 year old daughter with no known drug allergies and had no significant medical history who was described as a healthy girl. She was an active flutist, accomplished and participating in an adult orchestra in her hometown, a soccer player and track runner. On 26-AUG-2008, she was vaccinated with first dose of GARDASIL (Lot # 660555/0279X) and her second dose was administered on 03-DEC-2008 (Lot #660618/0572X). There were no concomitant medications or vaccinations. About mid February 2009 she started to develop what seemed at the time like a viral illness with a sore throat, felt unwell, developed a low grade fever and swollen glands. She rapidly progressed to severe headaches which were accompanied by nausea, photophobia, phonophobia, sensitivity to odors and a complete loss of appetite. The patient also developed severe lower limb weakness and balance/gait disturbance. A multitude of testing including two magnetic resonance imaging (MRI's), electromyography (EMG's), neurovascular checks (NVC's) and multiple labs had been unrevealing. She had been out of school since February 2009 with home tutoring. She became interested in nothing but laying on the couch in a dark and quiet room. She had been unable to tolerate her flute, and had no stamina for any activity including soccer and track. On 26-FEB-2009 the patient saw a doctor, to investigate if the patient was experiencing migraine headaches. Standard migraine treatment including IV DEPAKOTE had not been helpful. The patient was also treated with LORTAB and IMITREX which did not help. Her headaches worsened and were described as a 10 out of 10 on the pain scale and she began to have difficulty walking. She was then sent for a neurology consult and was treated with DEPAKENE and ANTIVERT with no effect. The patient had a battery of laboratory testing done (not otherwise specified) which revealed nothing. On 06-MAR-2009 the patient was seen in the Emergency Room (ER) due to her headache pain and inability to walk. She was seen by other doctor and treated with IV COMPAZINE, TORADOL and BENADRYL. While in the ER the patient became quite agitated, her father described it as "she went bizerk" as if she wanted to climb the walls. The patients father reported that the patient has an intense dislike for hospitals and really did not want to be in the ER. He also feels as though she may have had a reaction to COMPAZINE. They gave her DEPAKENE and REGLAN and felt somewhat better. The patient was placed on TOPAMAX. She was released to home from the ER, and was not admitted to the hospital. Her father reported that they continued to have phone consultations with the neurologist who increased the TOPAMAX and placed her on rizatriptan benzoate (MSD) as needed, but nothing seemed to help her headaches. On 18-MAR-2009 the patient underwent an MRI with venus and arterial phases which was negative. She follow-up with neurology and was placed on various vitamin supplements (therapy unspecified). On 06-APR-2009 steroids were tried, dexamethasone (dose not reported), with no effect. Laboratory tests were drawn (not specified) which revealed nothing out of range. On 13-APR-2009 she saw a doctor again who increased her TOPAMAX, which did not help her headaches. The patient was seen for a physical therapy evaluation, the result showed no vestibular abnormality. She was dragging her left foot and needs to "wall walk" at home. It was suggested that they try aggressive physical therapy, but they did not proceed. She was placed on low dose amitriptyline HCl (MSD) with questionable benefit and in late May 2009 and her TOPAMAX was discontinued. On an unspecified date, her amitriptyline HCl (MSD) was pushed up from 20 mg daily to 30 mg daily (at bedtime). She was seen by an ENT who conducted vestibular testing which came back negative. The patient underwent a second MRI which was negative, EMG's were all negative as was any nerve conduction testing. Throughout the summer she was started on cyproheptadine hydrochloride (MSD) which was suggested by another family and has seemed to help and improve her appetite. Her headaches have decreased to a 5 out of 10from a 10 out of 10, although continue to be present most of the time. She started to participate in physical therapy rehabilitation at a nearby rehabilitation hospital. The cardiac surgeon reported that "We had been this summer taking a very aggressive we were getting better approach with her, pushing her activities and taking her for therapy for her gait." As a result she has had an improvement in her walking and her strength but. The patient was previously wheelchair bound she did some walking on her own. The cardiac surgeon considered gait/balance disturbance, photophobia, phonophobia, severe headaches, severe lower limb weakness and complete loss of appetite to be disabling events. The reporter believed she made some progress though she was still severe incapacitated. This is one of several reports received from the same source. A lot check has been requested. Additional information has been requested.