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This is VAERS ID 267458

Case Details

VAERS ID: 267458 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Female  
Location: New York  
Vaccinated:2006-10-24
Onset:2006-10-24
   Days after vaccination:0
Submitted: 2006-11-14
   Days after onset:21
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 1 AR / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site pain, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0610USA13156

Write-up: Information has been received from a registered nurse concerning a female who on 24 Oct 2006 was vaccinated with Gardisil (yeast) (Lot #654540/0800F). The nurse reported that on 24 Oct 2006 the pre-filled syringe of the vaccine malfunctioned and small amount sprayed out of the syring while she was withdrawing the syringe and the patient received an incomplete dose of the vaccine. She thought most of the dose was administered. The patient also stated that "the vaccination hurt." Unspecified medical attention was sought. At the time of this report the patient''s outcome was unknown. Additional information has been requested. 01/05/2007 Information has been received from a registered nurse concerning a 18 year old female who at 12:30 on 24-OCT-2006 was vaccinated intramuscularly in the deltoid with GARDASIL (Lot#654540/0800F). The nurse reported that on 24-OCT-2006 the pre-filled syringe of the vaccine malfunctioned and a small amount sprayed out of the syringe while she was withdrawing the syringe and the patient received an incomplete dose of the vaccine. She thought most of the dose was administered. The patient also stated that "the vaccination hurt". Unspecified medical attention was sought. At the time of this report the patient''s outcome was unnknown. Additional information has been requested.


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