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This is VAERS ID 276104

Case Details

VAERS ID: 276104 (history)  
Age: 39.0  
Gender: Female  
Location: Colorado  
Vaccinated:2006-09-05
Onset:2006-09-05
   Days after vaccination:0
Submitted: 2007-04-05
   Days after onset:212
Entered: 2007-04-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653650/0696F / 0 UN / IM

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Inappropriate schedule of drug administration, Underdose
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Family history of cancer; Papilloma viral infection
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0611USA02401

Write-up: Initial and follow up information has been received from a health professional concerning a 39 year old whit female patient with NKDA and with HPV and with a family history of breast cancer (mother) who on 07, Nov 2006 was vaccinated with a second IM dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 654540/0800F) into the left deltoid. It was reported that the patient jerked her arm away and the needle came out of the patient''s arm and did not received a full dose of the vaccine. It was reported that it was "hard to tell how much of the injection was lost." "A 1/3 of the injection came out of the patient''s arm and what is left in the vial." It was recommended that the patient get re-vaccinated with dose number 2. The patient was "upset for the inconvenience" and the patient decided to discontinue the injection because she had a "bad experience", she already had HPV and she had trouble getting to the office. No symptoms were noted. A first dose of HPB rL1 6 11 16 18 VLP vaccine (yeast) (lot # 653650/0696F) was given IM into the deltoid on 05, Sep 2006. Additional information is not expected.


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