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This is VAERS ID 611113

Case Details

VAERS ID: 611113 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2015-11-22
Entered: 2015-11-23
   Days after submission:1
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: WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


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