Information has been received from a Medical Assistant concerning a 19 year old female who on 16-JUN-2008 was vaccinated intramuscularly with a 0.5 mL first dose of GARDASIL vaccine (yeast) (lot # 660389/1968U). Concomitant therapy included ethinyl estradiol/norethindrone acetate (LOESTRIN). On 16-JUN-2008 the patient developed left side (face, shoulder, neck and arm) warmth, tenderness, pain and swelling. The patient's left side (face, shoulder, neck and arm) warmth, tenderness, pain and swelling persisted. The patient sought medical attention during an office visit. It was reported that the patient returned to the office "today" (17-JUN-2008 at the time of the report) and was instructed by the Nurse Practitioner to take ibuprofen and call the office if her symptoms persisted. It was reported that the Nurse Practitioner gave the patient a lab order for a SED rate and CBC with differential. Additional information has been requested. This is in follow-up to report (s) previously submitted on 7/15/2008. Initial and follow-up information has been received from a Medical Assistant concerning a 19 year old female with chronic allergic rhinitis, who on 16-JUN-2008 at 11:00AM, was vaccinated intramusculary with a 0.5 mL first dose of GARDASIL vaccine (lot # 680389/1968U). Concomitant therapy included LOESTRIN, YASMIN 28, ALEGRA-D, minocycline hydrochloride (manufacturer unknown), NASACORT AQ and MOTRIN. On 16-JUN-2008 the patient developed left side (face, shoulder, neck and arm) warmth, tenderness, pain and swelling. The patient sought medical attention during an office visit on 17-JUN-2008. On examination the patient presented with clear nasal drip. Pertinent negatives included sinus congestion, dental pain, ear pain, and sore throat. The patient had left anterior cervical adenopathy (1 node) and tenderness across the left traper muscle, left deltoid. The patient was instructed by the Nurse Practitioner to take ibuprofen and call the office if her symptoms persisted. It was reported that the Nurse Practitioner gave the patient a lab order for a SED rate and CBC with differential, the body temperature 98.8 degrees and the blood pressure 114/78 were taken. On 19-JUN-2008, the patient returned to the physician's office and had the same side facial neck and posterior shoulder swelling, paresthesias and some pain. The patient is still taking MOTRIN. As of 19-JUN-2008, she had face on left side all swollen again and under the jaw. The patient had no fever but the areas of concer felt warm. It was reported that the injection site on left arm was doing fine. The physical exam showed no apparent distress, the patient was well nourished and well developed. The head and face were normalocephalic, the eyes showed no exophtalmus, papillary reaction was normal, and OEM was intact. The patient had normal tympanic membranes and hearing grossly was intact, the external nose was unremarkable, no mucosal abnormality of the nose was present. The sinus revealed tender maxillary, she had normal teeth and gums, normal tongue, her palate and uvula appeared symmetric and normal. The patient did not have pharyngeal erythema, exudiates or mucosal lesions. The respiratory tract was normal to inspection, lungs were clear to percussion and auscultation. The patient had regular cardiovascular rhythm, no murmurs, gallops or runs. The musculoskeletal evaluation showed tender left paraspinal cervical spine. Pulse 72 and blood pressure 100/60 were taken. The patient had pain rated 9 with 10 the most painful. As of 08-SEP-2008, the patient had recovered from the symptoms. No further information is available.