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This is VAERS ID 339771

Case Details

VAERS ID: 339771 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Illinois  
Vaccinated:2008-04-28
Onset:2008-10-26
   Days after vaccination:181
Submitted: 2009-02-09
   Days after onset:106
Entered: 2009-02-18
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1978U / 3 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Bloodclot~HPV (Gardasil)~3~13.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions: 5/7/09-records received-5/7/09-records received-office visit 4/21/00-evaluation for dehydration, vomiting, sore throat and febrile. Impression strep pharyngitis. 9/2/05-routine physical. Assessment:overweight. Office visit 1/4/08-C/O lump in neck noticed in 9/07. Intermittently hurts. Assessment:mild lymphadenopathy.
Allergies:
Diagnostic Lab Data: 3/9/09-records received-WBC 17.3.
CDC Split Type:

Write-up: She developed a pulmonary embolism after having 3 rounds of vaccine GARDASIL. She was a healthy, active teenager. 2/23/09-autopsy report received immediate cause:Massive pulmonary embolism. Mild cardiomegaly. Last several days C/O cough and congestion. 3/9/09-ED records received for DOS 10/26/08-presented in full cardiac arrest after suffering a full and prolonged cardiac arrest, aystole. Expired.


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