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This is VAERS ID 591496

Case Details

VAERS ID: 591496 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2015-08-25
Entered: 2015-08-25
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: 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: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


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