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This is VAERS ID 275023

Case Details

VAERS ID: 275023 (history)  
Age: 77.0  
Gender: Male  
Location: California  
Vaccinated:2007-02-06
Onset:2007-02-06
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:35
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other       Purchased by: Other
Symptoms: Incorrect dose administered, Incorrect drug dosage form administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0702USA00873

Write-up: Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gardasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.


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