| VAERS ID: | 425513 (history) | Vaccinated: | 2011-04-26 | | Age: | 18.0 | Onset: | 2011-04-28, Days after vaccination: 2 | | Gender: | Female | Submitted: | 2011-04-29, Days after onset: 1 | | Location: | Idaho | Entered: | 2011-06-16, Days after submission: 48 | |
| Life Threatening? No |
Died? Yes
Date died: 2011-04-28
Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: ORTHO CYCLEN | | Current Illness: (1) Depression/chronic; (2) ADHD; (3) acne severe | | Preexisting Conditions: | | Diagnostic Lab Data: None | | CDC 'Split Type': | |
