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This is VAERS ID 540269

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

Case Details

VAERS ID: 540269 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Submitted: 2014-08-19
   Days after onset:19
Entered: 2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Death
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-07-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.

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