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This is VAERS ID 338452

Case Details

VAERS ID: 338452 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Foreign  
Vaccinated:2008-10-20
Onset:2008-12-30
   Days after vaccination:71
Submitted: 2009-01-27
   Days after onset:28
Entered: 2009-01-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1316U / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-12-30
   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:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0901USA03040

Write-up: Information has been received from a health authority (reference # PEI2009000661) concerning a 15 year old female who on 20-OCT-2008 was vaccinated with the first dose of GARDASIL, lot #1427U (batch #NH15200) IM into the left upper arm. No information regarding toleration was given. On 29-DEC-2008, the patient was vaccinated with a second dose of GARDASIL, lot #1316U (batch #NH45640) IM into the left upper arm. On 30-DEC-2008 the patient died. According to the preliminary report, the autopsy showed no acute or chronic organic disease. The possibility of carbon monoxide intoxication was not yet ruled out. Investigation by public prosecution is ongoing. Lot checks have been requested. Other business partner numbers included: E2009-00404. Additional information has been requested.


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