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This is VAERS ID 487849

Case Details

VAERS ID: 487849 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Unknown  
Location: Foreign  
   Days after vaccination:53
Submitted: 2013-03-26
   Days after onset:26
Entered: 2013-03-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abortion, Exposure during pregnancy, Foetal death, Foetal disorder
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-02-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1303JPN010510

Write-up: Initial information has been received from a physician concerning a fetus patient. The patient''s mother on 05-JAN-2013 was vaccinated with the third injection of GARDASIL injection drug (injection site, dose and indication not reported). The information on concomitant medication was not reported. On 06-JUL-2012, the patient''s mother was vaccinated with the first injection. On 04-SEP-2012, the patient''s mother was vaccinated with the second injection. On 05-JAN-2013, the patient''s mother was vaccinated with the third injection. The patient''s mother was vaccinated at other health-care facility, after that visited the hospital. The last menses date was 03-JAN-2013. On 27-FEB-2013, the patient''s mother developed abortion. Gestational duration was 7 weeks. The cause of fetus''s death was an abortion by congenital anomaly. The reporting physician considered that the abortion was serious due to death and congenital anomaly. The reporting physician felt that the relationship between abortion and GARDASIL was unknown. Additional information has been requested.

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