Bartonella infection; lyme; bouts of anxiety; easily angry; rude, cranky and disrespectful; acute insomnia, then extreme insomnia; IBS-C (irritable bowel syndrome with constipation); intense pain in her bones and muscles; intense pain in her bones and muscles; exhaustion; high level of aluminum; immune system couldn't keep up; parasitic infection; Stretch marks; transforming into a different preson/rude cranky disrespectful/became crippled with anxiety; she could not focus on anything and did not seem to care; brain fog/ even felt like bugs were crawling inside her body, instead of brain disorder; treatment was given for IBS-C but it did not work; staring blankly; subtle shift in her behavior; strep throat; This spontaneous report was received from an author referring to her adolescent daughter.  On an unknown date (reported as a few years before), the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) administered for Human papillomavirus (HPV) prophylaxis (strength, route of administration, vaccination scheme frequency, anatomical location, dose, lot number and expiration date were not reported).  On an unknown date at afternoon, at the beach, the patient was noticed a strange rash on her back. It looked like a row of six thick, horizontal lines stretching across the middle of her back - almost like they had been carved with a knife. She was asked if it hurt or itched, and she said no. Even so, she was taken to see the doctor. The doctor said that that was weird, and it could be a jellyfish sting when the doctor examined her. The patient's parent told the doctor that the patient hadn't been in the water that day. The doctor concluded that it was stretch marks, and it would fade in time. It was reported that the patient was slender, which made her parent wonder how she could end up with stretch marks. But the doctor stuck to her diagnosis, and the parent let it go. Right around that time, the patient's behavior began to be noticed a subtle shift (Abnormal behavior). She started experiencing bouts of anxiety. She seemed to get easily angry.  On an unknown date (reported as that summer), the patient and her family went to the park, and they got stuck for about fifteen minutes in a boat. But a week or so later, out of the blue, the patient became crippled with anxiety about it. She couldn't stop thinking about it, and she spent two days in bed. She was terrified by the idea of cannibals existing in the world, the parent reasoned with her and reassured her, and finally she seemed to let go of her terror. The parent chalked it up to her nervousness about starting high school.  By the time her cases began on an unknown date, though, the patient was already transforming into a completely different person (Personality change). She was rude and cranky and disrespectful (Irritability), and for the first time, her grades started dropping. She began having acute insomnia and anxiety attacks that would leave her curled up on the floor in a blanket. At the mornings, the parent couldn't get her up for school no matter how hard they tried. The parent decided to take the patient out of school and have tutors come to our home instead. The patient made it through the ninth-grade curriculum. When the patient returned to school for her sophomore year, her struggle continued. She couldn't focus on anything and didn't seem to care (Disturbance in attention). At home she'd wrap herself in a blanket and lie on the foot for hours with her eyes closed or staring blankly. Her anxiety was so acute. She could barely function, and she'd miss days and even weeks of school. The parent suspected that Lyme disease might be the culprit in the patient's case. Therefore, the patient was taken to the doctor for blood work, and "CDC" Lyme screening test, but they were negative. The doctor declared and insisted that the patient didn't have Lyme. The doctor sent the patient and her parent home with no diagnosis. The parent reported that the patient was in the grip of something insidious and pernicious, and there was no one we could turn to for answers. A few months later, the patient was taken back to the doctor to have her retested for Lyme disease, but once again the screening came back negative. In order to rule out Lyme, the parent thought it need more advanced screening, such as the enzyme-linked immunosorbent assay (ELISA) test or the Western blot test. But the doctor considered the patient didn't need them and she wouldn't order them. At this point, the patient was suffering from extreme insomnia. She would stay up until three or four in the morning and be completely exhausted the next day. The parent arranged for her to be medically excused from attending classes and allowed to enroll in a home study program again. Then the patient continued to get worse. Often, she would get angry out of the blue and rage for hours at a time. Her anger would erupt like a volcano in the house. In fact, sometimes she would get so angry she would run out of the house. By then, the patient had developed severe stomach problems, and a gastroenterologist was added to the patient's team of doctors. The gastroenterologist diagnosed the patient with irritable bowel syndrome with constipation (IBS-C) and prescribed medication (unspecified) (strength, dose, frequency, lot# and expiry date not reported), but didn't seem to work (drug ineffective). The situation was only getting worse. It was reported that the patient had been diagnosed with strep throat (Pharyngitis streptococcal) earlier in the year. The parent made an appointment with a pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) specialist, she gave the patient the antibiotic amoxicillin, and within twenty-four hours some of her worst symptoms diminished. Another antibiotic, azithromycin, helped event more.   The parent reported that she got download that showed exactly how and why bartonella had overtaken the patient with such force. The patient had gotten the HPV vaccine quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) a few years before. It showed something in that particular vaccine had damaged her cells-literally infiltrated her "cell doors" and left them unable to close and lock and fight off disease, which meant that whatever attacked the patient was able to thrive. The mother took the patient to see the pediatrician and reported that how the HPV shot had damaged patient's cells. The doctor replied that the patient did not have bartonella and the HPV vaccine was perfectly safe. Then the doctor showed the parent a passage that said bartonella presented as a three-dot rash, not the kind of rash the patient had. The parent insisted that the doctor give the patient a blood test to screen for bartonella. The doctor agreed to run the test. Two days later, the test result came back with negative for bartonella. The parent got an appointment to see another doctor who was actively engaged in research toward a durable cure for Lyme in two weeks. He read through the patient's medical history, and he listened as the parent told him about her certainty that the patient had bartonella. He asked if patient had recently developed a certain symptom of IBS-constipation which would be a good indicator of bartonella. It was reported the patient had come down with it just a few months earlier. The doctor reply that IBS constipation was textbook bartonella, they often go hand in hand, and he would test the patient for Lyme. This time, he ran the more advanced ELISA and Western blot tests for Lyme, as well as a specialized test for bartonella. When the results came back, they showed that the patient had tested positive for Lyme disease and highly positive for bartonella (bartonellosis). In fact, the levels were so high, the doctor believed she'd likely had it for the past three years that exactly the span of the patient's ordeal. The doctor immediately put the patient on a treatment for Lyme and bartonella, and ultimately the parasites that often accompany those infections. The medication she took had its own hellish side effects-she experienced intense pain in her bones and muscles (myalgia), and once event felt like bugs were crawling inside her body (feeling abnormal)-but all of her psychiatric symptoms disappeared. The antibiotics seemed to get her anxiety under control, but the exhaustion (fatigue) and brain fog (feeling abnormal) that had now taken over were a constant battle. Therefore, the events of anxiety, anger, irritability, insomnia, personality change, disturbance in attention, staring, and abnormal behavior were resolved. The third doctor ran a cellular blood test and it showed a very high level oof aluminum inside patient's cells. And it was a type of aluminum specific to vaccines quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), the shot the patient had received for HPV. The doctor went on to explain that the aluminum stuck in patient's cells had damaged her mitochondria and thinned the membranes of her cell wells allowing whatever bacteria and viruses were present in her body to run rampant. Her cells literally couldn't shut their doors against the infections. Her immune system couldn't keep up (Immune system disorder). The doctor prescribed a protocol of intravenous (IV) treatment to restore the health of her cells and flush the aluminum out at the dame time, as well as numerous herbs and naturopathic treatment to treat any Lyme, bartonella, and parasitic infections that were present. The patient began getting better. She was improving. Her fatigue, bone ache, and brain fog also lifted. Her sleeping patterning was regulated. However, the outcome of events myalgia, drug ineffective, and pharyngitis streptococcal were not reported.  The reporter considered high level of aluminum and immune system disorder to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). The relationship between other events and quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) was not reported. Upon internal review, the events Lyme disease and Bartonella infection were determined to be medically significant.