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This is VAERS ID 791092

Case Details

VAERS ID: 791092 (history)  
Form: Version 2.0  
Sex: Male  
Location: Unknown  
Submitted: 0000-00-00
Entered: 2018-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Death

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:
Diagnostic Lab Data:
CDC Split Type: US0095075131812USA003910

Write-up: This media report was received from a consumer via vendor, concerning his son, a male patient of unknown age. The patient''s medical history, concurrent conditions and concomitant medications were not reported. On an unknown date, the patient was vaccinated with GARDASIL for prophylaxis (dose, route of administration, anatomical location, lot number and expiration date were not reported). On an unknown date, the patient experienced an unspecified adverse event. On an unknown date, the patient died (reported as "GARDASIL victim''s father testifies to vaccine approval committee"). The reporter did not provide neither the cause of death, nor if an autopsy was performed. The reporter considered GARDASIL to be related to the patient''s death. The causal relationship between adverse event and the suspect vaccine was not reported. This is one of several reports received from the same reporter. Sender''s Comments: US-009507513-1812USA004144.

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