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This is VAERS ID 417137

(NOTE: This result is from the 6/14/2018 version of the VAERS database)

Case Details

VAERS ID: 417137 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2011-01-04
Onset:2011-02-02
   Days after vaccination:29
Submitted: 2011-02-08
   Days after onset:6
Entered: 2011-02-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0096Z / 2 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3432AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NORINYL
Current Illness: none
Preexisting Conditions: Hay fever; Animal fur
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN1101

Write-up: Patient deceased within 30 days of vaccine administration.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=417137


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