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From the 9/14/2017 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 541916

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Case Details

VAERS ID: 541916 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Submitted: 2014-09-01
   Days after onset:13
Entered: 2014-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-08-19
   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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.

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