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This is VAERS ID 615613

Case Details

VAERS ID: 615613 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2015-12-18
Entered: 2015-12-18
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: WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


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