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This is VAERS ID 274124

Case Details

VAERS ID: 274124 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: New York  
Vaccinated:2007-02-01
Onset:2007-02-01
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:40
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Eye movement disorder, Incorrect dose administered, Medical device complication, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK; None
Current Illness:
Preexisting Conditions: UNK; None
Allergies:
Diagnostic Lab Data: UNK; None
CDC Split Type: WAES0702USA00744

Write-up: Information has been received from a licensed practical nurse concerning a 15 year old female with no medical history or allergies, who on 05-FEB-2007 was vaccinated with a dose of HPV (lot# 654540/1162F). On 05-FEB-2007 the nurse reported that the vaccine prefilled syringe malfunctioned. The nurse pushed the plunger down, the spring never activated and when she pulled the syringe out of the patient''s arm some of the liquid sprayed on the table and on the wall. The patient was not re-activated because of her reactions which were she "felt woozy" and her eyes were fluttering, and her whole body was shaking. It was noted that the patient did not lose consciousness. The patient will come back in two months to get re-vaccinated. Unspecified medical attention was sought. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. This is in follow-up to report(s) previously submitted on 3/14/2007. Information has been received from a licensed practical nurse concerning a 15 year old female with no medical history or allergies, who on 01-FEB-2007 was vaccinated with a dose of GARDASIL (lot# 654540/1162F). On 01-FEB-2007 the nurse reported that the vaccine prefilled syringe malfunctioned. The nurse pushed the plunger down, the spring never activated and when she pulled the syringe out of the patient''s arm some of the liquid sprayed on the table and on the wall. The patient was not re-vaccinated because of her reactions which were that she "felt dizzy" and her eye rolled upward, and her whole body was jerking. Upon calling the patient''s name, her eyes opened wide and focused on her mother and the nurse. Her body stopped jerking and she stated, "I just feel dizzy." It was noted that the patient did not lose consciousness. The patient rested a while on the exam table and walked out of the office on her own. The mother was instructed to call the office if anything appeared to be out of the ordinary. No call was received. The patient will come back in two months to get re-vaccinated. On 01-FEB-2007, the patient recovered. Additional information is not expected.


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