Information has been received from a physician concerning a 21 year old female who in November 2007, was intramuscularly vaccinated with the first dose of GARDASIL (dose and lot# not reported). The physician reported that the patient received the three dose series of GARDASIL "between November 2007 and June 2008." The patient was diagnosed with joint pain/arthritis in August 2008 and was currently being treated with methotrexate and prednisone. Physician noted the patient "went on a field camping trip two months after completing the GARDASIL series." Patient had no family history of arthritis. The patient sought unspecified medical attention. The patient had not recovered. Follow up information has been received from a medical assistant reported that the 21 year old female with on pertinent medical history and no known drug allergies on 15-MAR-2007 was vaccinated with the first dose of GARDASIL (lot# 657006/0188U), the second dose of GARDASIL (lot# 657736/0389U) on 17-MAY-2007, the third dose of GARDASIL (lot# 659437/1266U) on 19-NOV-2007 (dose not reported). No other vaccines received concomitantly and no concomitant therapies. The patient told doctor that symptoms began in August 2008 and she was subsequently diagnosed with rheumatoid arthritis. Information received from medical records reported that the 21 year old female (68", 123 lbs.) student experienced left wrist pain in July 2008. On 31-JUL-08, rheumatoid factor (RF) was 63 IU/ml. On 24-JUL-08, the patient was diagnosed with rheumatoid arthritis; diagnosed within 1 year of GARDASIL. It was noted that the patient has no family hx of rheumatoid arthritis or autoimmune disease. On 20-AUG-2008, RF was 70 IU/ml. Lyme Ab was 1.59 and the patient was prescribed antibiotics. The patient had pains in knuckles and shoulder. The patient had brief relief of pain from November 2008 to March 2009. In March 2009, pain recurred with sporadic bilateral knuckles and proximal interphalangeal (PIP) joint. In May 2009 pain was increasing. On 20-MAY-09, RF was 235 IU/ml. In Fall 2009, the patient had daily foot and hand pain. In Spring 2010, the patient had inflammation of left PIP and left elbow; immobile for 6 weeks. In May 2010, the patient attended physical therapy with steroid injection for left elbow. Rheumatologist started the patient on MOBIC. The patient had pain in jaw and clavicles. Foot pain was improved with MOBIC. In June 2010, the patient experienced immobility due to right knee swelling and inflammation related to jogging. The patient was treated with occasional methylprednisolone packs. In July 2010, Rheumatologist gave the patient cortisone injection in the knee. In July 2010, the patient required emergency room/ doctor visit for knee evaluation. It was noted that the patient had not recovered as this was considered a chronic illness. In August 2010, rheumatology evaluation; the patient started disease modifying meds (methylprednisolone 4mg BID, methotrexate   [Due to memory limitations, the remainder of this text could not be compared.]  trexate 2.5mg weekly, and folic acid 1mg). Rheumatoid arthritis was noted to require medical/ surgical intervention by the physician. Additional information is not expected. All available medical will be provided upon request.