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This is VAERS ID 558622

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2015

558622
VAERS Form:
Age:13.0
Gender:Female
Location:Idaho
Vaccinated:2014-06-30
Onset:2014-06-30
Submitted:2014-12-16
Entered:2014-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J008423 / - LA / IM

Administered by: Private      Purchased by: Public
Symptoms: No adverse event, Incorrect product storage

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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.


Changed on 9/14/2017

558622 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Idaho
Vaccinated:2014-06-30
Onset:2014-06-30
Submitted:2014-12-16
Entered:2014-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J008423 / - UNK LA / IM

Administered by: Private      Purchased by: Public
Symptoms: No adverse event, Incorrect product storage

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=558622&WAYBACKHISTORY=ON


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