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This is VAERS ID 284520

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 284520
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-29
Onset:2007-05-29
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0089U / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? 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':

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 a"ssistant 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


Changed on 12/8/2009

VAERS ID: 284520 Before After
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-29
Onset:2007-05-29
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0089U / - UN / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? 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': (blank) 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 a"ssistant assistant attempted to administer the vaccination, /"the "the plunger would not depress,/" 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 "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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284520&WAYBACKHISTORY=ON


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