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This is VAERS ID 283731

Case Details

VAERS ID: 283731 (history)  
Form: Version 1.0  
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 / 1 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
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: Unknown
Current Illness: Oral herpes; Asthma
Preexisting Conditions:
Allergies:
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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