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This is VAERS ID 836159

Case Details

VAERS ID: 836159 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Scleroderma
SMQs:, 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL010273

Write-up: SCLERODERMIA; This spontaneous report was received from agency on 20-SEP-2019, referring to a 16 unit unknown female patient. The patient''s medical history, concurrent condition and concomitant medication were unknown. On an unknown date the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown) (0 ml, frequency, route, batch/lot number and expiration date were not reported) or hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (manufacturer unknown) (0 ml, frequency, route, batch/lot number and expiration date were not reported) for prophylaxis. On an unknown date the patient experienced scleroderma. The event was attributed to vaccination or immunization. On an unknown date the patient died due to the event. It was unknown if an autopsy was performed. The agency considered the event of scleroderma to be possibly related to Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (manufacturer unknown) or HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast) (manufacturer unknown).; Reported Cause(s) of Death: SCLERODERMIA


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