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This is VAERS ID 778079

Case Details

VAERS ID: 778079 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2018-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Autoimmune disorder, Dizziness, Fatigue, Headache, Hypoaesthesia, Infection, Inflammation, Injury, Nausea, Neck pain, Paralysis, Rash, Rheumatoid arthritis, Sinus congestion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131810USA005156

Write-up: This spontaneous report was received from a physician via social media refers to a male patient of unknown age. The patient''s pertinent medical history, concurrent conditions and concomitant medications were unknown. On an unknown date, the patient was vaccinated with GARDASIL (lot#, expiry frequency, route and dose of administration unknown) for prophylaxis. Other suspect therapies included GARDASIL 9 (lot#, expiry frequency, route and dose of administration unknown) for prophylaxis. On an unknown date, the patient experienced auto immune disease (autoimmune disorder), side effect (adverse event), inflammation, neck pain, nausea, neck pain, rheumatoid arthritis, infection, injury, paralysis, tiredness (fatigue), rash, dizziness, arrhythmia, headache, fainting (syncope), numbness (hypoesthesia), and sinus congestion. The patient died on an unknown date.The outcome of arrhythmia, syncope, headache, dizziness, nausea, fatigue, inflammation, neck pain, adverse event, infection, injury, rash, hypoesthesia, sinus congestion, paralysis and rheumatoid arthritis was unknown. The causality of all the events were not reported. Upon internal review the events death, arrhythmia, autoimmune disorder, paralysis, and rheumatoid arthritis were considered to be medically significant.; Sender''s Comments: US-009507513-1810USA005156:


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