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This is VAERS ID 274197

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 274197 (history)  
Form: Version .0  
Age: 14.0  
Sex: Female  
Location: Texas  
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:33
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Incorrect dose administered, Injection site reaction, Medical device complication, Pain in extremity, Skin irritation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho Tri Cyclen Lo, Synthroid
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0702USA01341

Write-up: Information has been received from a licensed visiting nurse concerning a 14 year old female with no medical history and no known drug allergies, who on 08 Feb 2007 was vaccinated IM with a dose of Gardasil. Concomitant therapy included Ortho Tri Cyclen Lo and Synthroid. The patient inadvertently received less than the recommended dose and experienced an injection site reaction. The nurse withdrew the vaccine from a vial and the medication leaked near the hub of the syringe while administering it to the patient. The patient complained of irration on the left deltoid about a two inch radius from the injection site. She also reported that the pain "ran down" her left arm. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.

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