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This is VAERS ID 782839

Case Details

VAERS ID: 782839 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2018-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown       Purchased by: ?
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075131810USA012438

Write-up: This initial spontaneous report was received on 25-OCT-2018 from a physician via a company field representative and refers to a 12 year old patient of unknown gender. The patient had no pertinent medical history or drug reactions/allergies and was taking no concomitant medications. On an unspecified date, the patient received GARDASIL intramuscularly for the indication of human papilloma virus (HPV) vaccination (dose and lot # not provided). It was unspecified how many doses in the series the patient received. An unspecified period of time after receiving GARDASIL, the patient died. Cause of death was not specified. There were no lab diagnostics/studies performed. The physician did not provide causality assessment. The physician told the field representative that Merck was sued. Upon internal review, death was considered medically significant. Additional information has been requested.; Reported Cause(s) of Death: Cause of Death: Unknown by reporter.


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