National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 274124

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274124
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-05
Onset:2007-02-05
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Dizziness, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

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: UNK
CDC 'Split Type':

Write-up:Information has been received from a licensed practical nurse concerning a 15 year old female 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 wo


Changed on 12/8/2009

274124 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-05
Onset:2007-02-05
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dizziness, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

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: UNK
CDC 'Split Type': (blank) WAES0702USA00744

Write-up:Information has been received from a licensed practical nurse concerning a 15 year old female 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 The nurse pushed the plunger down, the spring never activated and when she pulled the syringe out of the patient''''s 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 wo "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.


Changed on 3/2/2010

274124 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-05 2007-02-01
Onset:2007-02-05 2007-02-01
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - - UN / - UN

Administered by: Other Private      Purchased by: Other Private
Symptoms: Dizziness, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
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 UNK; None
Current Illness:
Preexisting Conditions: UNK UNK; None
Allergies:
Diagnostic Lab Data: UNK 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 wi


Changed on 4/7/2010

274124 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-01
Onset:2007-02-01
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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; 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 wi


Changed on 1/4/2011

274124 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-01
Onset:2007-02-01
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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; 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 wi will come back in two months to get re-vaccinated. On 01-FEB-2007, the patient recovered. Additional information is not expected.


Changed on 6/14/2014

274124 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-01
Onset:2007-02-01
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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; 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.


Changed on 5/14/2017

274124 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-01
Onset:2007-02-01
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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; 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.


Changed on 9/14/2017

274124 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-02-01
Onset:2007-02-01
Submitted:2007-03-14
Entered:2007-03-16
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, Tremor, Medical device complication, Eye movement disorder, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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; 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.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=274124&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166