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This is VAERS ID 558622

Case Details

VAERS ID: 558622 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Idaho  
Vaccinated:2014-06-30
Onset:2014-06-30
   Days after vaccination:0
Submitted: 2014-12-16
   Days after onset:169
Entered: 2014-12-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J008423 / UNK LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Incorrect product storage, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1412USA007471

Write-up: Information was received from a certified nurse assistance regarding a 13 year old female patient who was administered GARDASIL (lot # J008423) injection intramuscular 0.5ml in left deltoid on 30JUN2014. The GARDASIL was involved in a temperature excursion. No adverse event was reported. Please see additional information for other cases reported by same provider. Additional information is not expected.


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