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This is VAERS ID 284520

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284520
VAERS Form:
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
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
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

284520 Before After
VAERS Form:
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
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
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.


Changed on 9/14/2017

284520 Before After
VAERS Form:(blank) 1
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 / - UNK UN / UN

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 (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
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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