First Appeared on 12/30/2006 |
| VAERS ID: |
264774
|
Vaccinated: |
2006-09-26 |
| Age: |
23.0 |
Onset: |
2006-09-26 |
| Gender: |
Female |
Submitted: |
2006-10-13 |
| Location: |
New York |
Entered: |
2006-10-17 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: |
| Other Medications: NONE |
| Current Illness: |
| Preexisting Conditions: Concurrent conditions: cervical dysplasia, colposcopy |
| Diagnostic Lab Data: NONE |
| CDC 'Split Type': |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) |
MERCK & CO. INC. |
|
0 |
|
|
|
| Administered by: Other
Purchased by: Unknown |
| Symptoms: Dizziness, Medication error, Pain |
| Write-up: Information has been received from a nurse practitioner concerning a 23 year old female with mild cervical dysplasia with colposcopy and no known allergies or adverse drug reactions reported. On 26-SEP-2006, the patient was vaccinated with the first dose"of 0.5 mL of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication reported. It was reported that the pre-filled syringe had been stored at 34F. On 26-SEP-2006 the patient developed severe pain during administration with lightheadedn |
|
|
Changed on 12/8/2009 |
| VAERS ID: |
264774 Before
After
|
Vaccinated: |
2006-09-26 |
| Age: |
23.0 |
Onset: |
2006-09-26 |
| Gender: |
Female |
Submitted: |
2006-10-13 |
| Location: |
New York |
Entered: |
2006-10-17 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: |
| Other Medications: NONE |
| Current Illness: |
| Preexisting Conditions: Concurrent conditions: cervical dysplasia, colposcopy |
| Diagnostic Lab Data: NONE |
CDC 'Split Type':
(blank)
WAES0609USA08128 |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL)/HPV (GARDASIL) |
MERCK & CO. INC. |
|
0 |
|
|
|
| Administered by: Other
Purchased by: Unknown/Other |
| Symptoms: Dizziness, Medication error, Pain |
Write-up:
Information has been received from a nurse practitioner concerning a 23 year old female with mild cervical dysplasia with colposcopy and no known allergies or adverse drug reactions reported. On 26-SEP-2006, the patient was vaccinated with the first dose"of dose of 0.5 mL of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication reported. It was reported that the pre-filled syringe had been stored at 34F. On 26-SEP-2006 the patient developed severe pain during administration with lightheadedn lightheadedness and dizziness. The patient was laid on the exam table and given ibuprofen (MOTRIN) for pain. The patient sought unspecified medical attention. At the time of this report, the patient had recovered from the events. Additional information has been requested.
|
|
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