Age: 9.0
Sex: F
Vaccine: HEPA
Symptoms: Vomiting, Vulvovaginitis, White blood cell count normal
Clinical narrative: Information has been received from a physician concerning a 9 year old female with reactive airways disease (RAD) and allergies to PEDIAZOLE and watermelon and a history of small abscess on right thigh, possible pustule/abscess near right eye, tiny pustule in left eyebrow, visual disturbance, viral infection, upper respiratory tract infection, staphylococcal infection on nose, sinus tachycardia, loss of consciousness, impetigo, head injury, pilomatricoma, 2 degree eustachian tube dysfunction, ear pain and learning disability-reading (all reported in 0909USA00549) who on 30-JUL-2001 and 09-SEP-2002 was vaccinated IM in the deltoid with a first and second 0.5 ml doses of VAQTA (Lot # of the first dose 639363/0649L).  Concomitant therapy included albuterol.  On 31-JUL-2001 the patient presented to her physician's office with complaint of tired lately.  Physical examination showed no abnormality.  According to the physician, the patient was healthy.  On 27-AUG-2001 she developed smashed thumb at school and was seen by her doctor.  Physical examination showed left thumb swollen, discoloration, and reluctant range of mobility.  The physician's assessment was injured thumb.  KEFLEX 500 mg three times a day for 10 days was prescribed.  On 26-NOV-2001 the patient presented with intermittent fever, sore throat and lightheaded.  She also had headaches on and off.  The physician's assessment was probable sinusitis.  AMOXICILLIN was prescribed.  On 11-DEC-2001 she was seen by the doctor with intermittent fever to 101, night sweats and laryngitis symptoms which seemed to have resolved.  She had no other symptoms.  The physician's assessment was fever, unknown etiology.  Complete blood cell count with differential was within normal limits.  Paranasal sinuses X ray revealed bilateral mucoperiosteal thickening of the maxillary sinuses more severe on the right consistent with chronic sinusitis.  On 04-APR-2002 the patient presented with ear pain which began "2 days ago" (02-APR-2002) and fussy.  She had recent upper respiratory infection and some asthma cough.  The physician's assessment was otolgia.  They would observe for the symptoms.  If symptoms worsened, she would return to the office.  On 21-MAY-2002 the patient was seen by the doctor complaining of barking cough and fever (temperature up to 102).  The physician's assessment was croup.  She was given supportive care and observation for symptoms.  If symptoms worsened, she would return to the office.  On 25-MAY-2002 the patient was placed on therapy DELSYM cough suppressant, 2 tsp every 6 hours for the treatment of cough.  On 09-SEP-2002 the patient had a well visit with no concerns.  Physical examination showed several small nevi on palms.  She was sent for dermatologist evaluation.  On 17-JAN-2003 the patient was seen for upper respiratory infection symptoms for a week.  She was placed on syrup measures.  On 20-MAR-2003 the patient presented with warts on right feet.  Physical examination showed plantar warts.  The warts were removed.  She would have follow-up if not resolving.  On 10-NOV-2003 the patient was seen again for plantar warts.  There were multiple planter warts on foot.  Curettage was done and she was sent for dermatologist evaluation.  On 23-JUN-2004 the patient presented with rash which started on 22-JUN-2004.  Initially there were a few bumps, and at the time she was seen, there were a lot.  Physical examination showed some diffuse tan, sometimes pink lesions on trunk and leg.  There are some lesions with pustule.  The physician's assessment was possible pigmented purpuric eruption.  She was sent to dermatologist evaluation.  On 23-JUL-2004 the patient was seen for coughing worsened.  She coughed a lot and was using albuterol inhalation every 4 hours, but not much helpful.  She had cough for 4-5 days.  She had no fever, no upper respiratory infection symptoms.  The physician's assessment was cough, likely asthma.  She was treated with albuterol as needed and FLOVENT 2 puffs twice a day.  On 30-JUL-2004 she had a follow-up visit.  It was reported that her cough was much better with FLOVENT.  On 03-NOV-2004 the patient presented with headache backache, sinus tachycardia for 3 days, some cough and diarrhea.  She had no fever, no vomiting.  Her appetite decreased.  It did not feel like asthma.  Physical examination showed mild pharyngeal erythema.  The assessment was upper respiratory infection.  Treatment plan included fluid and humidity.  On 05-NOV-2004 she was seen again.  It was reported that she continued to have headache and backache.  She was hurt when she went to the bathroom.  All labs were normal.  The physician's assessment was viral illness and possible vulvovaginitis.  Treatment plan included rest and push fluids.  On 18-APR-2005 the patient presented with cough, sinus tachycardia and running nose.  She felt tired. Albuterol helped her stop coughing for 1 and 1.5 hours.  The physician's assessment was asthma and possible sinusitis.  She was treated with FLOVENT, albuterol and Z-PAK.  On 06-SEP-2005 she was seen by the doctor for headache, barking cough, sinus tachycardia which started on 03-SEP-2005.  Her chest felt right.  Albuterol helped some.  She had no fever.   The physician's assessment was cough, headache, and laryngitis.  It was likely viral illness.   Treatment plan included increasing fluid, ibuprofen and albuterol as needed.   On 23-SEP-2005 the patient went to see the doctor again.  She still had headache, cough became better.  She had bad cramps, nausea and missed school in her period.  The physician's assessment was headache and dysmenorrheal.  On 20-OCT-2005 she presented with stomach pains on and off.  "Four days ago" (on 16-OCT-2005) she had acute onset of back and abdominal pain.  She took NAPROSYN.  It got worse that day.  The pain located in right upper abdomen and back.  She had nausea without vomiting.  Physical examination showed mild tender in central upper abdomen.  Complete blood cell with differential showed normal white blood cell, aspartate aminotransferase, alanine transaminase.  The physician's assessment was abdominal pain (right upper quadrant).  Right lower quadrant and pelvis sonogram was performed on 24-OCT-2005 for pain.  The impression included: right lower quadrant imaging was gassed out bowel, therefore, the appendix was not visualized; free fluid within the cul-de-sac slightly greater than expected for physiologic reasons; other normal pelvic sonogram.  On the same day enhanced CT of abdomen and pelvis was also performed for vomiting.  The impression included: mild proximal small bowel dilatation without delay in the transit of oral contrast associated with trace free fluid in the pelvis.  Differential would include ileus versus early small bowel obstruction.  Clinical correlation was needed; no evidence of an abscess of free air.  In October 2005, the patient developed ovarian cyst.  On 09-JAN-2006 the patient was seen for possible toe infection.  The physician's assessment was ingrown nail.  KEFLEX 500 mg twice a day was prescribed.  On 23-FEB-2006 the patient underwent an operation.  Preoperative diagnosis was right lower quadrant pain.  During the operation, the GYN team operated on the patient for endometriosis and further investigation of the pain.  She had a cystectomy.  Since she had constant right lower quadrant pain, the appendix was removed as well so that she would not be suspected of having appendicitis every time she presented with abdominal pain to the emergency room.  On 03-MAR-2006 the patient presented with burning urination which started that day.  She had no fever or vaginal discharge.  She was on AUGMENTIN.  The physician's assessment was vulvovaginitis.  On 21-MAR-2006 the patient was seen for fever and shortness of breath.  She woke up early with shortness of breath and fever.  Albuterol did not help much.  The assessment was croup.   PREDNISONE 40 mg once a day for 3 days was prescribed.   On 30-JUN-2006 the patient went to see her doctor to get a CT to rule out ovarian cysts.  CT of pelvis with contrast was performed on 26-JUL-2006 to evaluate ovarian cyst.  The results showed unremarkable pelvis aside form a small amount of free fluid.  On 06-APR-2007 the patient presented with right middle finger infection.  It looked worse that day.  She also had abdominal pain, nausea every day without vomiting.  Physical exam showed right 3rd finger with purulent.  Purulent fluid was expressed.  PRILOSEC 20 mg once daily was prescribed for abdominal pain.   The patient subsequently developed adverse events after vaccination with GARDASIL (WAES #0908USA03159).  Additional information is not expected.