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This is VAERS ID 836910

Case Details

VAERS ID: 836910 (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 - / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Encephalomyelitis
SMQs:, Noninfectious encephalitis (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL011026

Write-up: Encephalomyelitis; Information has been received from the Regulatory Authority (2019PVCL2614) on 20-SEP-2019, concerning to female patient of 13 age (units not provided); The patient''s pertinent concurrent conditions, concomitant therapies, drug reactions and allergies were not provided. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown), or hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (manufacturer unknown), the dose was 1200 milligram as prophylaxis (the concentration, frequency, route and anatomical location of administration, lot number and expiration date were not reported). On an unknown date, the patient experienced encephalomyelitis. The outcome of encephalomyelitis was reported as fatal. It was unknown if an autopsy was performed. The causality assessment between HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast) (manufacturer unknown) and Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (manufacturer unknown) and encephalomyelitis was not reported by the Health Authority.


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