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This is VAERS ID 573733

Case Details

VAERS ID: 573733 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
Submitted: 2015-01-14
Entered: 2015-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Immunisation
Preexisting Conditions: GARDASIL, toleration was not reported
Diagnostic Lab Data:
CDC Split Type: WAES1501DEU003164

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR control# E2015-00044) on 09-JAN-2015. Case of fatal outcome was received from a healthcare professional on 07-Jan-2015. Case is medically confirmed. Case is linked with E2014-00045, -00046 and -00047 (same reporter, same vaccine, different reactions), with E2014-00048, -00049, -00050 and -00051 (same reporter, different vaccine, different reactions). A 16-year-old female patient received a second dose of GARDASIL (lot-no. not reported) on an unspecified date three to four years ago. Unspecified time later she developed a pulmonary embolism and died. It was unknown if the patient took oral contraceptives. First dose of GARDASIL was given on an unspecified date. Toleration was not reported.

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