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This is VAERS ID 634742

Case Details

VAERS ID: 634742 (history)  
Form: Version 1.0  
Sex: Unknown  
Location: Unknown  
Submitted: 2016-05-06
Entered: 2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: 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? 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:
Diagnostic Lab Data:
CDC Split Type: WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.

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