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This is VAERS ID 558704

Case Details

VAERS ID: 558704 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Idaho  
Vaccinated:2014-08-05
Onset:2014-08-05
   Days after vaccination:0
Submitted: 2014-12-16
   Days after onset:133
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: 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: WAES1412USA007469

Write-up: Information was received from a certified nurse assistant regarding a 12 year old male patient who was administered GARDASIL (lot # J008423) injection intramuscular 0.5ml in left deltoid on 05AUG2014. The GARDASIL was involved in a temperature excursion. No adverse event was reported. Additional information is not expected.


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