Information has been received from a physician concerning a female patient with a history of mouth ulcers who on an unknown date was vaccinated with a dose of GARDASIL, lot # unspecified. The patient came back to the physician's office 4 hours after getting GARDASIL with "vulvar ulcers" diagnosed as "bipolar aphthosis". The physician stated that the patient had gotten the shot when she was experiencing symptoms of West Nile virus; however it was not diagnosed after she had been given GARDASIL. The patient became sexually active "shortly before" she got GARDASIL. At the time of reporting, the outcome of the event was unknown. Follow-up information was received from the physician who reported that the patient had a history of canker sores. The physician also reported that the patient had a viral illness (not specified) prior to receiving the third dose of GARDASIL. The physician stated that the patient had experienced bipolar aphthosis every month for over one year. Follow-up information was received from the physician, who reported that the patient was vaccinated with the third dose of GARDASIL IM, on 18-AUG-2007. The physician reported that within 4 hours of vaccination, the patient had the first outcome of nonherpetic vulvar ulcers. Major work up negative. Presumed to be bipolar aphthosis. At the time of reporting, the patient had not recovered. The patient had numerous cultures and laboratories (unspecified) and a presumptive positive West Nile virus test. The physician considered the event to be disabling. This is one of two reports from the same source. No further information is available.   2/17/09 Received Immunology Clinic records of 7/15-9/26/2008. FINAL DX: Bechet's disease Records reveal patient did not have symptoms when initially evaluated.  Valtrex d/c.  Had bout of depression w/suicidal ideation.  Being seen by counselor & tx w/meds. Developed oral canker sores that waxed & waned & by 9/18 had over 40+ vulvar ulcers w/exudate & bilateral lymph node adenopathy.  Depression aggravated by eruption, fever 100.5, flu like s/s of aches/pain all over.  Developed fine erythematous rash over face & skin next day that waxed & waned.  Continues to self cath.  Tx w/steroid burst & antibiotics.  Improved w/steroids  2/18/09 Received ID clinic records of 4/12-5/21/2008 which revealed no new information.  1/20/09 Received PCP office records 4/8-12/3/2008. FINAL DX: suspect bipolar aphthosis Records reveal patient had cleaned out pond 8/2007.  Dx w/WNV & had recurring symptoms since then of: 7-14 day menses, facial warmth, painful oral & vaginal lesions, dysuria requiring self catheterization.  Lesions are blisters that ooz yellow fluid & also red bumpy itchy rash on trunk & arms.  Skin painful during these episodes.  Fevers up to 101,(+) inguinal nodes, axillary nodes.  Not sexually active.  Tx w/antivirals, pain meds & antigout med.  Referred to ID  2/5/09 Received GYN medical records of 8/28/2007-11/25/2008. FINAL DX: Bechet's syndrome records reveal patient seen 8/28/07 in f/u on vulvar operations that were felt to be response to viral illness.  Patient was feeling better, lesions were resolving w/o pain.  RTC 10/15/07 w/vaginal lesions; numbness & tingling of LEs; intermittent recurrent vision loss; and mouth lesions x 3 days.  Referred to Neuro.  RTC 12/10/07 & record states pt w/known West Nile virus x approx 5 mo.  RTC 2/28/08 w/hirsutism & acne.  Added yaz to glucophage & valtrex already on.  Labs ordered.  RTC 3/17/08 w/recurrent vaginal lesions x 2 days & sore throat x 2 weeks.  Records state HSV IgM (+) 12/2007.  Patient had self d/c valtrex due to increased depression.  Dx w/HSV outbreak w/superimposed cellulitis.  RTC 7/08 & referred to university specialist.  RTC 10/29 & given trial of colchicine as recommended by specialist.  RTC 11/25/08 w/recurrent outbreak of vulvar ulcers most c/w Bechets.  Tx w/meds.