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Life Threatening? No
Write-up: Initial and follow-up information has been received from a Medical Assistant concerning a 17 year old female patient who on 15-MAR-2007 was vaccinated IM with her first dose of Gardasil, lot #654702/0011U. The reporter reported soon after the injection "her arm hurt really bad" and was stiff. On 16-MAR-2007 the patient developed sporadic twitching of her whole body. The reporter stated that the patient "looked as if she had Tourette syndrome. " On 17-MAR-2007 the patient was examined in the emergency room and was released a few hours later. She was examined by her primary physician and gynecologist. She had an appointment with a neurologist. She has not had any improvement in her symptoms of sporadic twitching, however arm pain and stiffness were subsiding. The reporter considered the events to be disabling because the patient was unable to perform her activities of daily living for a week. Additional information has been requested. 7/7/2009 Neuro consult received for 3/20/07-4/13/07 with DX: Intermittent myoclonus. Pt presented for consult after developing twitching in the L leg and shoulder which developed on 3/16/07, one day after receiving HPV vax in R deltoid. Pt also c/o shoulder pain and RUE pain making it difficult to use the R arm. Pt c/o increasing frontal H/A since that time as well. Plantar responses were flexor on the right and extensor on the left. Intermittent jerky movement mostly upper part of body toward left shoulder and rarely in the legs. F/U 3/30/07 with continued H/A and blurred vision but improvement in twitching. RUE pain improved, but now sharp pain in top of neck. Tx with Naproxen which was later d/c due to epigastric pain. Topamax started. 7/14/09 PCP records recd. Seen 3/19/07 for dx: motor twitching. See neuro records. 7/17/09 ER records received DOS 3/17/07 to 3/18/07. Assessment: Shoulder Twitching. Patient presented with sudden onset left shoulder twitching (intermittent). Left shoulder muscle pain. Ativan prescribed, symptom improved, and patient discharged.
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