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This is VAERS ID 318491

Case Details

VAERS ID: 318491 (history)  
Form: Version 1.0  
Gender: Female  
Location: Unknown  
Submitted: 2008-07-07
Entered: 2008-07-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Death, Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Sulfonamide allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0806USA08737

Write-up: Information has been received from a physician who was told by a patient''s mother that a female patient with a sulfa allergy who on an unspecified date was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported), which was well tolerated. On an unspecified date, the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). Subsequently the patient died. The cause of death was reported as allergic reaction to GARDASIL. The physician stated that the patient who died was not her patient and she knew no further details. Follow-up information was received from the physician who reported that a other of one of her patients had said to her, that she "thought" she read this report on the internet. The physician asked the patient''s mother to find out where she read the report. The patient''s mother could not find the report and did not know where to locate the source information. Additional information has been requested.

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