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This is VAERS ID 836917

Case Details

VAERS ID: 836917 (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: Bacterial infection, 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: CO0095075131909COL011454

Write-up: BACTERIAL INFECTION; Information has been received from the Regulatory Authority on 20-SEP-2019, regarding a female patient of unknown age. The patient''s pertinent past medical history, concurrent conditions, concomitant therapies, drug reactions or allergies were not provided. On an unspecified 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 reported as 10 milligram as prophylaxis. (strength, frequency, route, anatomical location of administration, lot number and expiration date were not provided). On an unspecified date, the patient experienced bacterial infection. On an unspecified date, the patient died of unknown cause. 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 bacterial infection was not provided by the Health Authority.; Reported Cause(s) of Death: unknown cause of death


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