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This is VAERS ID 836501

Case Details

VAERS ID: 836501 (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: 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: CO0095075131909COL010776

Write-up: This spontaneous report was received from a Regulatory Authority and refers to a female patient of age 16 (units not reported). The patient''s concurrent condition included lupus erythematosus. No information regarding the patient''s medical history and concomitant medications were provided. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (Types 6,11,16,18) recomb. vaccine (manufacturer unknown) for prophylaxis (dose reported as 1 with units unspecified; strength, route, anatomical location, lot # and expiration date were not reported). On an unknown date, the patient experienced eritematosus lupus empeoring (systemic lupus erythematosus). On an unknown date, the patient died. The cause of death was unknown. It was also unknown if autopsy was performed. No diagnostic results were reported. The Agency considered event systemic lupus erythematosus to be serious and 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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