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Write-up: Information has been received from Sanofi Pasteur MSD (DE-1577272925-E2013-09192) on 22-NOV-2013 as part of a business agreement via a consumer on 12-Nov-2013, additional information received on 14-Nov-2013. Reporting form was received from a health care professional on 21-Nov-2013. Case is medically confirmed. A female patient, received a complete vaccination series with three doses of GARDASIL IM on 11-Apr-2007 (D1, batch-no. NE45050, lot-no. 655376/0572F, 05-MAY-2009), on 11-Jun-2007 (D2, batch-no. NE35170, lot-no. 655101/0513F, exp 01-MAY-2009) and on 18-Oct-2007 (D3, batch-no. NF37110, lot-no. 1537F, exp 15-DEC-2009). In fall 2007 at the age of 14 years, some time between D2 and D3, the patient developed muscle induration affecting the whole body with changing localisation, abdominal cramps and severe watery and foamy diarrhoea, pain with changing localisation, but especially of the back and frequent infections. Recurrent episodes occurred during 2008 and 2009 and the patient''s health deteriorated. Since 2010, the intensity increased and the patient''s quality of life was extremely reduced. During an outpatient consultation on 05-Mar-2010 due to juvenile hypertension diagnosed one year before with systolic blood pressure values fluctuating profoundly between 70 and 230, therapy with BLOPRESS was suggested. ECG and colour Doppler echocardiography on 05-Mar-2010 were without pathological findings. Lab tests on 05-Mar-2010 did not show any signs of pheochromocytoma. Thorax CT on 27-Oct-2010 was without pathological findings. MRI of the abdomen on 04-Nov-2010 was without pathological findings. Lab tests on 08-Nov-2010 showed CK at 1740 U/l. The patient was hospitalized from 17-Nov-2010 to 18-Nov-2010 due to unclear temporary increase of CK, severe fatigue since about half a year, pain localized in various areas and intermittent headache. The patient reported, that her feet hurt after only about 20 min of walking. Towards the evening she regularly suffered from leg oedema up to the middle of the lower leg. The patient experienced a weight gain of 10 kg within 1 year and subfebrile body temperature of approximately 38 degrees C. Furthermore, she reported of diffuse pressure pain on the chest. Medication on admission included candesartan cilexetil and SYMBICORT. 24-hour collected urine test was without pathological findings. Rheumatoid diagnostic revealed normal ranges of complement factor C3 and C4, and overall complement CH50, cardiolipin IgG and IgM were within normal ranges. Microbiological serology revealed Chlamydia pneumonia IgG 303.9 AU/ml (positive), IgA 26.3 AU/ml (marginal positive) and Mycoplasma pneumonia MPP titer <1:40 (negative). Virological serology revealed Coxsackie-virus antibody KBR* titer 1:20, VZV IgG positive, VZV IgM negative, HIV antigen/antibody negative, HAV IgG positive, anti-HAV IgM negative, HBs-antigen negative, anti-HBs $g1000 mIU/ml, anti-HBc negative, and anti-HCV negative. Immunopathology was without pathological findings, p-and cANCA were not evident and there were no signs of connective tissue disease. During the hospital stay malignoma and myositis were excluded. On 04-Jan-2011 the patient experienced severe back pain. An emergency doctor diagnosed a nerve compression. The symptoms improved under TRAMAL and tetrazepam therapy. On 14-Jan-2011, the patient presented to the outpatient ward of a medical clinic with the diagnosis of juvenile hypertension. Sonography of wrists showed a mild effusion in left wrist. Lab tests on 14-Jan-2011 showed leukocytes 15210 1/ul and TSH 2.54 mU/l. It was reported, that since corticosteroid therapy (start date not reported) the symptoms had improved slightly, but the condition was "not good". The patient''s symptoms had improved slightly under corticosteroid therapy (oral prednisolone). A whole body MRI was conducted on 09-Feb-2011 due to increased CK up to 1700 of unknown etiology at the end of 2010, pain in the wrist joint and for examination of the sacroiliac
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