Information has been received from a physician and a licensed practical nurse concerning a 13 year old female with no pertinent medical history or no known drug allergies, who on 24-SEP-2009 was vaccinated with 0.5 ml of the first dose of GARDASIL (Lot number 659655/1486U) intramuscularly on the right arm. On the same day the patient received a dose of hepatitis A vaccine (inactive) (AVENTIS) (Lot number: AHAVB291AA) on the right arm, a dose of VARIVAX (Lot number: 661334/0737X) on the right arm, MENACTRA (Lot number U2663AA) left arm. The patient became lightheaded, had pain at the injection site, was dizzy and experienced numbness on the right leg while still in the office after vaccination. the patient was told if the symptoms got worse, to call the office or go to the emergency room (ER). The patient continued to feel bad, vomited and felt weak so the patient went to the ER. The patient was hydrated and got better. The physician reported that the patient recovered maybe on 01-OCT-2008, reported as "1 week after the first dose of GARDASIL". On 25-SEP-2009, the patient was in the office for a well visit and received the second dose of GARDASIL (Lot number 662404/0312Y) on the left arm, a dose of influenza virus vaccine (unspecified) (Lot number: U3177AA) and a dose of hepatitis A virus vaccine inactivated (Lot number 663913/0206Y) on the right arm. The patient then experienced severe pain at the injection site on the left arm. The nurse put ice on the injection site because the pain was so extreme the patient was crying. The patient was told to call the office if the symptoms got worse. The patient went to the ER. The patient had no fever. The ER notes from 27-SEP-2009, at 17:30 stated that the patient started to feel, on 25-SEP-2009, lightheaded and complained of pain all over-severe myalgia. The patient had difficulty moving her left arm and left leg. The patient got better 26-SEP-2009, but symptoms got worse 27-SEP-2009 night. The patient had nausea, dizziness sometimes, tired, aches and pains all over the body, and difficulty standing for more than 30 minutes (uses a cane and is slow to walk ). On 29-SEP-2009, the patient was in the office, and she was still with aches and pains, especially the shoulder and joints that were not swollen but tender. The patient complained "it hurts" and she could hardly move. The patient took an ALEVE on 28-SEP-2009. On 27-SEP-2009 or 28-SEP-2009 night, the patient had shortness of breath. The patient was instructed by the mother who is a nurse) to breath in a paper bag and the patient felt better. There were no respiratory problems at the office visit on 29-SEP-2009. The patient had severe myalgia and the patient was not recovered. A complete blood cell count and basal metabolic were normal. The patient was referred to see a neurologist (no other details available). It was unknown if events were life threatening (no mention in chart). Lightheaded and dizzy, pain at the injection  site, numbness on the right leg, feel bad, vomited, felt weak, severe pain at the injection site, crying, lightheaded and dizziness, tired, tired, tired, tired, pain all over, severe myalgia, difficulty standing for more than 30 minutes, nausea, shoulder and joints are tender, shortness of breath and can't hardly move were considered to be disabling by the physician. Additional information has been requested.    11/17/2009 PCP and ED record for 9/24 and 9/25/2009.  Dx acute medication reaction  Patient with c/o's generalized weakness, Headache, fatigue and myalgias.  neuro exam WNL, Tx IVF.