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This is VAERS ID 558704

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2015

558704
VAERS Form:
Age:12.0
Gender:Male
Location:Idaho
Vaccinated:2014-08-05
Onset:2014-08-05
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: 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': 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.


Changed on 9/14/2017

558704 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Male
Location:Idaho
Vaccinated:2014-08-05
Onset:2014-08-05
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: 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': 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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=558704&WAYBACKHISTORY=ON


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