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This is VAERS ID 387594

(NOTE: This result is from the 6/2/2010 version of the VAERS database)

Case Details

VAERS ID: 387594 (history)  
Form: Version .0  
Age: 11.0  
Sex: Female  
Location: Foreign  
Vaccinated:2010-01-22
Onset:2010-04-28
   Days after vaccination:96
Submitted: 2010-05-14
   Days after onset:16
Entered: 2010-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-04-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100602&IDNUMBER=387594


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