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This is VAERS ID 836490

Case Details

VAERS ID: 836490 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2019-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiopulmonary failure, Death
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

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: CO0095075131909COL010185

Write-up: Cardiorespiratory failure; This spontaneous report was received from Health authority referring to a female patient. Age was reported as 16(units not reported). The patient''s concurrent condition, medical history and concomitant therapy details were not reported. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown) dose reported as 1(units not reported) (strength, route, lot# and expiry date were not reported) for prophylaxis. On an unknown date, the patient experienced cardiorespiratory failure (cardiopulmonary failure). The outcome of cardiopulmonary failure was reported as fatal. The cause of death was unknown. It was unknown if autopsy was performed. The Agency considered cardiopulmonary failure to be possibly related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown).; Reported Cause(s) of Death: unknown cause of death

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