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This is VAERS ID 277918

Case Details

VAERS ID: 277918 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: West Virginia  
Vaccinated:2007-04-20
Onset:0000-00-00
Submitted: 2007-04-23
Entered: 2007-05-04
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1813BA / 6 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1492F / 2 UN / SC

Administered by: Public       Purchased by: Public
Symptoms: Medical device complication, No adverse effect, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV0707

Write-up: Box of DTaP placed with Tdap. Pt given DTaP instead of Tdap. No adverse reactions.


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