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This is VAERS ID 836098

Case Details

VAERS ID: 836098 (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: Condition aggravated, Death, Systemic lupus erythematosus
SMQs:, Systemic lupus erythematosus (narrow), Immune-mediated/autoimmune disorders (narrow)

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: Lupus erythematosus
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL011382

Write-up: Erythematosus lupus empeoring; This spontaneous report was received from a regulatory authority and refers to a 16 (units not provided) female patient. There was no information about the patient''s concomitant therapies or medical history provided. Her concurrent conditions included lupus erythematosus. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (manufacturer unknown) (second dose, frequency, route of administration, anatomical location, lot # and expiration date were not provided) for prophylaxis. On an unknown date, the patient experienced worsening of lupus erythematosus and died due to it on an unknown date. It was unknown if autopsy was performed. The relatedness between the event and quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (manufacturer unknown) was reported as possible.; Reported Cause(s) of Death: Systemic lupus erythematosus

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