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This is VAERS ID 558704

Case Details

VAERS ID: 558704 (history)  
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 / - LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Incorrect storage of drug, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
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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