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This is VAERS ID 836503

Case Details

VAERS ID: 836503 (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: 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL010836

Write-up: eritematosus lupus empeoring; 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 0 milliliter (strength, route, lot# and expiry date were not reported) for prophylaxis. On an unknown date, the patient experienced eritematosus lupus empeoring (Systemic lupus erythematosus). The outcome of Systemic lupus erythematosus was reported as fatal. Cause of death was unknown. It was unknown if an autopsy was performed. The Agency considered Systemic lupus erythematosus 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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