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This is VAERS ID 274109

Case Details

VAERS ID: 274109 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: New York  
Vaccinated:2006-11-08
Onset:2006-11-08
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:125
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / UNK - / -

Administered by: Other       Purchased by: Private
Symptoms: Accidental exposure, Incorrect dose administered, Sensory disturbance, Vaccination complication
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: food allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0611USA02972

Write-up: Initial and follow up information has been received from a nurse practitioner concerning a 22 year old female student with no acute illness or chronic disease and food allergy to eggplant who on 08 Nov 2006, at 14:00, was vaccinated witha second dose of Gardasil. It was reported that the patient pulled away during adminstration due to "strange sensation" and a significant amount medication went down the patient''s arm. It was estimated that only one third to one half of the dose was administered. It was reported that the patient had to repeat the second. On 08 Nov 2006, the patient recovered from the event. No further information is available.


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