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This is VAERS ID 284520

Case Details

VAERS ID: 284520 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Pennsylvania  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:16
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Medical device complication

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: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA05644

Write-up: Initial and follow-up information has been received from a physician and a medical assistant concerning a 13 year old female patient who on 29-MAY-2007 was scheduled to be vaccinated with a dose of Gardasil (Lot #655324/0089U). However, when the medical assistant attempted to administer the vaccination, "the plunger would not depress," and blood was aspirated into the syringe. The CMA added that she had made 2 unsuccessful attempts to get the syringe to work. The physician reported that "the UltraSafe mechanism had not activated," so the patient did not get the vaccination, and had to be rescheduled " due to a defective (Gardasil) syringe." Follow up information received from a nurse, confirmed the above events, and added that actually there was no medication in the syringe. She reported the patient still has not received the vaccination. No further information is expected.

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