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This is VAERS ID 575160

Case Details

VAERS ID: 575160 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:625
Submitted: 2015-02-20
   Days after onset:4
Entered: 2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2015-02-20
   Days after onset: 4
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:
Diagnostic Lab Data:
CDC Split Type: WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.

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