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This is VAERS ID 837420

Case Details

VAERS ID: 837420 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiopulmonary failure, Death
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (broad), Respiratory failure (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: CO0095075131910COL000718

Write-up: CARDIORESPIRATORY FAILURE; This spontaneous report as received from a regulatory authority refers to a female patient (age reported as 16 (units not provided). No information on patient''s concurrent conditions, medical history and concomitant medications was provided. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) dose reported as 4 (lot#, expiration date, route of administration were not provided) for prophylaxis. On an unknown date, the patient experienced cardiorespiratory failure. The outcome of the event was reported as fatal. The patient died on an unknown date, it was unknown if an autopsy was performed. The relatedness between the event and the vaccination with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) was not provided.; Reported Cause(s) of Death: CARDIORESPIRATORY FAILURE


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