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This is VAERS ID 391439

Case Details

VAERS ID: 391439 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2010-06-24
Entered: 2010-06-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Death
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1006USA02143

Write-up: Information has been received from a Registered Nurse concerning an 18 year old female patient with a history of seizures prior to GARDASIL, who on an unspecified date was vaccinated with a dose of GARDASIL. The nurse advised that the patient experienced seizure and subsequent death after receiving GARDASIL. It was not advised which injection in the series caused the adverse experience or how the injection was administered. The health care professional was contacted by telephone and call would not supply the following information: patient name, date of birth, dates of vaccination/therapy, dose number, lot number and date of event. Seizure was considered to be disabling and immediately life-threatening. Additional information has been requested.


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