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This is VAERS ID 267458

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267458
VAERS Form:
Age:
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0800F / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site pain, Medication error, Post vaccination syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a female who on 24 Oct 2006 was vaccinated with Gardisil (Lot #654540/0800F). The nurse reported that on 24 Oct 2006 the pre-filled syringe while she was withdrawing the syringe and the pati"ent 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.


Changed on 12/8/2009

267458 Before After
VAERS Form:
Age:
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0800F / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site pain, Medication error, Post vaccination syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0610USA13156

Write-up:Information has been received from a registered nurse concerning a female who on 24 Oct 2006 was vaccinated with Gardisil (Lot #654540/0800F). The nurse reported that on 24 Oct 2006 the pre-filled syringe while she was withdrawing the syringe and the pati"ent patient received an incomplete dose of the vaccine. She thought most of the dose was administered. The patient also stated that /"the "the vaccination hurt./" hurt." Unspecified medical attention was sought. At the time of this report the patient''''s patient''s outcome was unknown. Additional information has been requested.


Changed on 2/5/2010

267458 Before After
VAERS Form:
Age:(blank) 18.0
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / - 0 - AR / - IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Injection site pain, Medication error, Post vaccination syndrome, Vaccination complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 3/14/2014

267458 Before After
VAERS Form:
Age:18.0 8.0
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 AR / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Vaccination complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 6/14/2014

267458 Before After
VAERS Form:
Age:8.0
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 AR / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Vaccination complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 3/14/2015

267458 Before After
VAERS Form:
Age:8.0
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 AR / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Vaccination complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2017

267458 Before After
VAERS Form:(blank) 1
Age:8.0
Gender:Female
Location:New York
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 1 AR / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Vaccination complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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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