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This is VAERS ID 274197

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274197
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site reaction, Pain in extremity, Skin irritation, Medical device complication, 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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08 Feb 2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen"Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the


Changed on 12/8/2009

274197 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site reaction, Pain in extremity, Skin irritation, Medical device complication, 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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0702USA01341

Write-up:Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08 Feb 2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen"Lo Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. 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

274197 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site reaction, Pain in extremity, Skin irritation, Medical device complication, 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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0702USA01341

Write-up:This is in follow-up to report (s) previously submitted on 3/14/2007. Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08 Feb 2007 08-Feb-2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. Information has been received from a licensed vocational nurse concerning a 14 year old female with a thyroid condition and irregular periods and no known drug allergies, who on 08-FEB-2007 was vaccinated IM with a dose of GARDASIL (lot# 654741/0013U). Concomitant therapy included ORTHO TRI-CYCLEN LO and SYNTHROID. The patient inadvertently received less than the recommeded dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. In follow-up, the nurs reported that the patient received a partial vaccination of GARDASIL (lot# 654741/0013U) in the left deltoid due


Changed on 4/7/2010

274197 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Burning sensation, Injection site irritation, Pain in extremity, Medical device complication, Underdose

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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0702USA01341

Write-up:This is in follow-up to report (s) previously submitted on 3/14/2007. Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08-Feb-2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. Information has been received from a licensed vocational nurse concerning a 14 year old female with a thyroid condition and irregular periods and no known drug allergies, who on 08-FEB-2007 was vaccinated IM with a dose of GARDASIL (lot# 654741/0013U). Concomitant therapy included ORTHO TRI-CYCLEN LO and SYNTHROID. The patient inadvertently received less than the recommeded dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. In follow-up, the nurs reported that the patient received a partial vaccination of GARDASIL (lot# 654741/0013U) in the left deltoid due


Changed on 1/4/2011

274197 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Burning sensation, Injection site irritation, Pain in extremity, Medical device complication, Underdose

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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0702USA01341

Write-up:This is in follow-up to report (s) previously submitted on 3/14/2007. Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08-Feb-2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. Information has been received from a licensed vocational nurse concerning a 14 year old female with a thyroid condition and irregular periods and no known drug allergies, who on 08-FEB-2007 was vaccinated IM with a dose of GARDASIL (lot# 654741/0013U). Concomitant therapy included ORTHO TRI-CYCLEN LO and SYNTHROID. The patient inadvertently received less than the recommeded dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. In follow-up, the nurs reported that the patient received a partial vaccination of GARDASIL (lot# 654741/0013U) in the left deltoid due to a defective syringe: some of the medication ran down the patient''s arm. The patient complained of a burning sensation and "beesting-like" reaction later that evening on 08-FEB-2007. By the morning on 09-FEB-2007, the patient''s are was much better. The immunization was discontinued. Addtitional information is not expected.


Changed on 6/14/2014

274197 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Burning sensation, Injection site irritation, Pain in extremity, Medical device complication, Underdose

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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0702USA01341

Write-up:This is in follow-up to report (s) previously submitted on 3/14/2007. Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08-Feb-2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. Information has been received from a licensed vocational nurse concerning a 14 year old female with a thyroid condition and irregular periods and no known drug allergies, who on 08-FEB-2007 was vaccinated IM with a dose of GARDASIL (lot# 654741/0013U). Concomitant therapy included ORTHO TRI-CYCLEN LO and SYNTHROID. The patient inadvertently received less than the recommeded dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. In follow-up, the nurs reported that the patient received a partial vaccination of GARDASIL (lot# 654741/0013U) in the left deltoid due to a defective syringe: some of the medication ran down the patient''s arm. The patient complained of a burning sensation and "beesting-like" reaction later that evening on 08-FEB-2007. By the morning on 09-FEB-2007, the patient''s are was much better. The immunization was discontinued. Addtitional information is not expected.


Changed on 5/14/2017

274197 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Burning sensation, Injection site irritation, Pain in extremity, Medical device complication, Underdose

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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0702USA01341

Write-up:This is in follow-up to report (s) previously submitted on 3/14/2007. Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08-Feb-2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. Information has been received from a licensed vocational nurse concerning a 14 year old female with a thyroid condition and irregular periods and no known drug allergies, who on 08-FEB-2007 was vaccinated IM with a dose of GARDASIL (lot# 654741/0013U). Concomitant therapy included ORTHO TRI-CYCLEN LO and SYNTHROID. The patient inadvertently received less than the recommeded dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. In follow-up, the nurs reported that the patient received a partial vaccination of GARDASIL (lot# 654741/0013U) in the left deltoid due to a defective syringe: some of the medication ran down the patient''s arm. The patient complained of a burning sensation and "beesting-like" reaction later that evening on 08-FEB-2007. By the morning on 09-FEB-2007, the patient''s are was much better. The immunization was discontinued. Addtitional information is not expected.


Changed on 9/14/2017

274197 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2007-02-08
Onset:2007-02-08
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Burning sensation, Injection site irritation, Pain in extremity, Medical device complication, Underdose

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: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0702USA01341

Write-up:This is in follow-up to report (s) previously submitted on 3/14/2007. Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08-Feb-2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. Information has been received from a licensed vocational nurse concerning a 14 year old female with a thyroid condition and irregular periods and no known drug allergies, who on 08-FEB-2007 was vaccinated IM with a dose of GARDASIL (lot# 654741/0013U). Concomitant therapy included ORTHO TRI-CYCLEN LO and SYNTHROID. The patient inadvertently received less than the recommeded dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. In follow-up, the nurs reported that the patient received a partial vaccination of GARDASIL (lot# 654741/0013U) in the left deltoid due to a defective syringe: some of the medication ran down the patient''s arm. The patient complained of a burning sensation and "beesting-like" reaction later that evening on 08-FEB-2007. By the morning on 09-FEB-2007, the patient''s are was much better. The immunization was discontinued. Addtitional information is not expected.


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