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This is VAERS ID 836574

Case Details

VAERS ID: 836574 (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: Autoimmune nephritis, Death
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), 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: CO0095075131909COL011757

Write-up: Autoimmune nephritis; Information has been received from the Agency on 24-SEP-2019. This spontaneous report has been received from regulatory authority referring to a female patient, age reported as "16". Information regarding the patient''s medical history, drug reactions or allergies, concurrent conditions and concomitant medications was not provided. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine(manufacturer unknown) dose 2 (strength, frequency, route, anatomical location, lot # and expiration date were not provided) for prophylaxis. On an unknown date, the patient experienced autoimmune nephritis (death and medically significant), subsequently, on an unknown date, the patient died. It was not known if an autopsy was performed. The reporter considered autoimmune nephritis to be related to Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine(manufacturer unknown). The Agency considered the event to be serious.

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