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This is VAERS ID 320909

Case Details

VAERS ID: 320909 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-07-30
Entered: 2008-07-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Fatigue, Injection site pain, Viral infection
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA04740

Write-up: Information has been received from a physician concerning a 22 year old female who on an unspecified date was vaccinated with her third dose of GARDASIL. Subsequently the patient experienced soreness at the injection site and fatigue. The outcome of soreness at the injection site and fatigue was not reported. Two months after receiving her third dose of GARDASIL, the patient died. The cause of death was "viral insult to the heart". Unspecified medical attention was sought. Follow-up information was received via telephone call from the physician. The patient was a family member. She did not have the vaccination dates or lot numbers since she did not give them. The physician reported that the patient''s mother thought that the patient died related to GARDASIL. She did not have the cause of death. The physician refused to provide patient information, information was gave to the coroner. The physician considered "viral insult to the heart" to be immediately life-threatening and disabling. Additional information has been requested.


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