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This is VAERS ID 424381

Case Details

VAERS ID: 424381 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Foreign  
Vaccinated:2011-02-15
Onset:2011-04-03
   Days after vaccination:47
Submitted: 2011-05-31
   Days after onset:58
Entered: 2011-06-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1016Z / 3 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal pain, Death
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2011-04-07
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA03118

Write-up: Information has been received from a physician as part of the GARDASIL Access Program concerning a female who entered a HPV vaccine pilot project. On 15-FEB-2011 was vaccinated with 3rd dose of GARDASIL (lot # 666987/1016Z). The patient was admitted to hospital with abdominal pain and distension on 03-APR-2011. The patient died on hospital on 07-APR-2011. The cause of death was abdominal pain and abdominal distension. The reporting physician felt that abdominal pain (grade 5) and abdominal distension (grade 5) were not related to GARDASIL. Abdominal pain (grade 5) and abdominal distension (grade 5) were considered to be immediately life-threatening. A lot check has been initiated. Additional information has been requested.


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