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This is VAERS ID 582025

Case Details

VAERS ID: 582025 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:454
Submitted: 2015-06-11
   Days after onset:41
Entered: 2015-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Condition aggravated, Death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Cardiac disorder; Systemic lupus erythematosus
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1506COL004105

Write-up: This spontaneous report was received a social media, TV news refers to a 16 year old female patient. The patient''s current condition included lupus and unspecified heart disease and medial history was not reported. On an unknown date in February 2014, the patient was vaccinated with second dose of GARDASIL (vial and prefilled syringe) intramuscularly (strength and frequency were not reported). Concomitant medications were not reported. On an unknown date after vaccination patient experienced fainting and worsening of pre-existing conditions (Lupus (death, life threatening and medically significant) and unspecified heart disease (death and life threatening). The outcome of worsening of pre-existing conditions (Lupus and unspecified heart disease) was reported as fatal. The outcome of fainting was unknown. The patient died on an unknown date in May 2015. The cause of death was unknown. The relatedness of the events with the quadrivalent human papillomavirus (types 6, 11, 16, 18) recomb. Vaccine was not reported. Upon internal review, worsening of pre-existing conditions (Lupus) was determined to be serious as another important medical event. Additional information is not expected as the contact details were not reported.

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