National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 457904

Case Details

VAERS ID: 457904 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
   Days after vaccination:3
Submitted: 2012-06-21
   Days after onset:14
Entered: 2012-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound
SMQs:, Suicide/self-injury (narrow), Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-06-07
   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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.

New Search

Link To This Search Result:

Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166