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This is VAERS ID 538295

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 538295 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2014-07-30
Onset:2014-07-30
   Days after vaccination:0
Submitted: 2014-07-31
   Days after onset:1
Entered: 2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-07-30
   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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiorespiratory arrest and death.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=538295


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