Information has been received from a registered dietician concerning her 17 year old daughter who on 07-FEB-2011, was vaccinated with the first dose of GARDASIL (route not reported) (lot number 666987/1016Z). "Shortly after the first dose" (on an unknown date), the daughter developed severe inflammation and pain in her fingers, toes and wrists. On 11-APR-2011, was vaccinated with the second dose of GARDASIL (route not reported) (lot number 667866/1437Z). "After the second dose" (on an unknown date), the pain and inflammation became worse. The dietician stated her daughter had been a gymnast and she initially felt her pain was from this, but rheumatologist had stated it might be linked to GARDASIL. The dietician reported that at one point, her daughter was not able to tie her own ponytail because of the pain. When her daughter laid her hand flat and putted pressure on it, she had pain. At the time of the report the patient had not recovered. Follow up information has been received from the mother of the patient the registered dietician and the physician. The mother who reported that her daughter did not received any concomitant vaccinations when the GARDASIL were administered. There was no family history of arthritis. On 25-MAY-2011, the daughter had been seen by her pediatrician. The mother reported that her daughter had pain in her hands, wrist and toes and intermittent swelling in her ankles. The mother reported that her daughter was "trying to push through to maintain her activities". The daughter was undergoing testing and the diagnosis was unknown at that time (no results were provided). The patient's next appointment with the rheumatologist would be in early June. At the time of the report the patient had not recovered. A worker from the physician's office reported that the patient developed joint inflammation two months after the GARDASIL vaccination had been administered. The office worker reported that the physician was not sure if the joint inflammation was related to GARDASIL. Follow up information has been received from the mother of the patient and a certified medical assistant. The medical assistant who reported that the patient with no allergies or drug reactions and no pertinent medical history was vaccinated in 07-FEB-2011 and on 11-APR-2011, with GARDASIL intramuscularly. (The medical assistant provided conflicting information that the first dose on 07-FEB-2011 was lot #1437Z). There was no concomitant medication. The medical assistant stated that starting "in February or March", the patient developed joint pain and swollen toes. The mother of the patient stated best guess was that first symptoms pain, swelling, arthralgia, arthritis mostly in wrist and fingers appeared 15-20 days after her first dose. The medical assistant reported that a specialist ruled out rheumatoid arthritis. The medical assistant reported that these problems made it difficult for the patient to get around. The medical assistant reported that on 25-MAY-2011, the patient came to the office. A serum B19 virus immunoglobulin G antibody test was performed (no results were provided). The patient did not receive any treatment for the event. As of 31-MAY-2011, the medical assistant stated that the patient had not recovered. Also reported by the mother of the patient on 01-JUN-2011, as the symptoms had been getting better, but were not 100% improved (still had pain and swelling). The events of joint pain and swollen toes were considered to be disabling by the certified medical assistant. Additional information has been requested.