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This is VAERS ID 558701

Case Details

VAERS ID: 558701 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Idaho  
Vaccinated:2014-07-02
Onset:2014-07-02
   Days after vaccination:0
Submitted: 2014-12-16
   Days after onset:167
Entered: 2014-12-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J008423 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Incorrect storage of drug, 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: WAES1412USA007473

Write-up: Information was received from a certified nurse assistant regarding a 14 year old male patient who was administered GARDASIL (lot # J008423) injection intramuscular 0.5ml in right deltoid on 02JUL2014. 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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