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This is VAERS ID 541912

Case Details

VAERS ID: 541912 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted: 2014-09-01
   Days after onset:5
Entered: 2014-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-08-27
   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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


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