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This is VAERS ID 375036

Case Details

VAERS ID: 375036 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Foreign  
Vaccinated:2007-05-22
Onset:2007-07-11
   Days after vaccination:50
Submitted: 2009-12-23
   Days after onset:896
Entered: 2009-12-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 1 UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autopsy, Death, Osteitis
SMQs:, Osteonecrosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-07-15
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


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