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This is VAERS ID 558701

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2015

558701
VAERS Form:
Age:14.0
Gender:Male
Location:Idaho
Vaccinated:2014-07-02
Onset:2014-07-02
Submitted:2014-12-16
Entered:2014-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J008423 / - RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Incorrect storage of drug, No adverse event

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': 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.


Changed on 9/14/2017

558701 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Male
Location:Idaho
Vaccinated:2014-07-02
Onset:2014-07-02
Submitted:2014-12-16
Entered:2014-12-17
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

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': 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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=558701&WAYBACKHISTORY=ON


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