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This is VAERS ID 283731

Case Details

VAERS ID: 283731 (history)  
Age: 16.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-01-18
Onset:2007-01-18
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:146
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1163F / 0 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Drug administered at inappropriate site, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Oral herpes; Asthma
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA03786

Write-up: Initial and follow up information has been received from an office manager in a physician''s office, concerning a 16 year old black female patient with no known drug allergies, oral herpes and asthma who on 18-JAN-2007 at approximately 3:30pm, was vaccinated IM in the right gluteal, with the first dose of Gardasil (Lot #654540/1163F). The patient experienced some pain during the administration of the vaccine (previously reported as no symptoms), but subsequently recovered (date unspecified). The patient''s mother, who was a nurse, had questioned the office3 about the effectiveness of the vaccine, after she received training of correct Gardasil administration. On 19-MAR-2007, at approximately 3:45pm, the patient received the second dose, IM in the right deltoid, of Gardasil (Lot #654702/0011U), with no problems reported. No further information is expected.


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