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This is VAERS ID 835954

Case Details

VAERS ID: 835954 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2019-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Skin depigmentation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL010677

Write-up: DEPIGMENTATION OF THE SKIN; This spontaneous report was received from the Agency (HA ref # 2019PVCL1500) and refers to a 9 (age units not reported) female patient. There was no information about the patient''s concurrent conditions, concomitant therapies, drug reactions, allergies or medical history provided. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown) dose reported as 200 milligram (strength, frequency, route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis. On an unknown date, the patient experienced depigmentation of the skin due to which she died on an unknown date. It was unknown if the autopsy was done. The Agency considered the event of depigmentation of the skin to be possibly related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown).; Reported Cause(s) of Death: DEPIGMENTATION OF THE SKIN

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