Information has been received from a physician concerning a female patient about 20 years old who on an unspecified date was vaccinated with a dose of GARDASIL. It was reported that 2 months after GARDASIL the patient developed fatigue and generalized adenopathy. The patient consulted with the physician. It was reported that the patient had not recovered at the time of the report. Additional information has been requested. This is in follow-up to report (s) previously submitted on 6/12/2009; 6/18/2009; 6/30/2009.  Information has been received from a physician concerning a female patient about 20 years old who on an unspecified date was vaccinated with a dose of GARDASIL.  It was reported that 2 months after GARDASIL the patient developed fatigue and generalized adenopathy.  The patient consulted with the physician.  It was reported that the patient had not recovered at the time of the report.  Information has been received from a physician via medical record concerning an 19 year old white student patient with allergy to apricots, cherries and almonds, a non smoker, rare alcohol user, she was sexually active and did have safe sexual practices, she was an immune competent patient, right handed and history of migraines, eczemn and cat scratch disease who on 15-AUG-2008 and in November 2008 was vaccinated with the first and second dose of GARDASIL.  Other medications included ZYRTEC for which had been on for 8 years and birth control pills (unspecified) over the last year.  The patient was evaluated for ongoing fatigue and intermittent adenopathy.  It was reported that in September had developed a sore throat and question if the diagnosis had been a strep throat.  She had been ill for about two weeks with arthralgias and myalgias.  Just feeling poorly and subsequently after that developed bilateral rib pain that she felt was at the level of the ribs themselves.  It was reported that she had not been doing any excessive coughing, but just had ongoing pain.  At that particular time, did not receive any antibiotic therapy.  It was reported that subsequently improved through the rest of the month, and then in early October while playing soccer had caused some damage to her rib cartilage with ongoing pain at that time.  The patient then continued to show signs of improvement up until the end of October, where had ongoing increasing levels of fatigue, headache, intermittent adenopathy and continued through December, January and February to the point where she had a difficult time making it through her classes.  She stated that her T-max had been approximately 101, which is high for the patient.  She has had intermittent changes in her appetitie and extreme mood swings.  She felt that her hands and feet had also been fairly cold.  She states also has had intermittent left abdominal pain and felt as if there's a bubble there that's going to pop.  At one time, she also did have associated tachycardia.  Through this course of work up, the patient did have a positive ASO and did receive a 10 day course of penicillin in mid-March.  Work up had consisted through a very thorough work up from a physician, as well as a cardiologist.  One other symptom patient had complained of was shortness of breath that had been subsequently improved.  The patient's mother on this interview also intervened, stating that the patient did have two injections of HPV vaccine in August and November.  Follow-up information was received from the practice manager in the physician's office.  It was reported that on 19-AUG-2008 (previously reported as 15-AUG-2008) the patient was vaccinated with the first dose of GARDASIL (lot # 660612/0229X).  On 24-NOV-2008 the patient was vaccinated with the second dose of GARDASIL (lot # 661703/0651X).  There were no other vaccines given on those dates.  The patient was seen in the office in February 2009 with complaint of fatigue.  The patient was last seen in their office on 04-JUN-2009 for a migraine.  The practice manager could not answer whether or not the patient had recovered from all of the other events.  This is an amended report.  The adverse event "left abdominal pain" was added.  Additional information has been requested.  All available medical records will be provided upon request.  This is a corrected report, as amended.