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This is VAERS ID 379874

Case Details

VAERS ID: 379874 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Foreign  
Vaccinated:2009-07-16
Onset:2009-08-29
   Days after vaccination:44
Submitted: 2010-02-08
   Days after onset:163
Entered: 2010-02-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 LA / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Completed suicide, Death, Poisoning
SMQs:, Suicide/self-injury (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2009-08-29
   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: WAES1001USA03762

Write-up: Information has been received from a physician concerning a 14 year old school going girl (ID#: -3/09) who received the first dose of GARDASIL in left deltoid, on 16-JUL-2009. Concomitant therapy included indigo. During the process of community mobilization for second dose, the female health worker was informed that the patient committed suicide on 29-AUG-2009 by consuming insecticide. The postmortem was performed on 30-AUG-2009. This event occurred after 45 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge, which was then communicated to Immunization Officer. The medical officer in charge investigated the death and completed first information report as per guidelines and determined the death was not related to the vaccine and so no further investigations were done. No further information is available.


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