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This is VAERS ID 350228

Case Details

VAERS ID: 350228 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2009-06-09
Onset:2009-06-12
   Days after vaccination:3
Submitted: 2009-06-25
   Days after onset:13
Entered: 2009-06-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1477U / 1 UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma, Autopsy, Condition aggravated, Death
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-06-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives (unspecified)
Current Illness:
Preexisting Conditions: Asthma bronchial
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0906USA04039

Write-up: Information has been received from a gynaecologist concerning an approximate 14 year old female patient with a history of bronchial asthma, who was vaccinated with a first dose of GARDASIL (lot # not reported) IM into the upper arm on 09-JUN-2009. On 12-JUN-2009, the patient experienced an asthmatic attack of which she died. The patient had no long-term medication for the asthma but only on occasion. Concomitant medication included hormonal contraceptives (unspecified). Reportedly, an autopsy was performed. The result is not yet known. A causal relation to the GARDASIL vaccine was considered unlikely by the vaccinating physician. Follow-up information received on 22-JUN-2009: Exact birth date, initials, height (158 cm) and weight (50 kg) as well as lot # 1477U, batch # NH25390 were provided. Following information gathered by phone from the reporting physician, the girl experienced the asthmatic attack at home and an emergency doctor was called. He was not able to arrest the attack and resuscitation was unsuccessful. Other business partner''s numbers included: E2009-05085.


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