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This is VAERS ID 276104

Case Details

VAERS ID: 276104 (history)  
Form: Version 1.0  
Age: 39.0  
Gender: Female  
Location: Colorado  
   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 / 1 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
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? 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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