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This is VAERS ID 836903

Case Details

VAERS ID: 836903 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

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: CO0095075131909COL010629

Write-up: DEATH; This spontaneous report was received from a regulatory authority refers to a female patient of unknown age. The patient''s pertinent medical history, concurrent conditions and concomitant medications were unknown. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown) 160 milligram (strength, route of administration, lot/batch # and expiration date were not reported) for prophylaxis. On an unknown date, the patient died. The cause of death was not reported (outcome was reported as not recovered/not resolved). It was unknown if autopsy was performed or not. Causality assessment between the suspect product and the event was not reported.; Reported Cause(s) of Death: unknown cause of death


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