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This is VAERS ID 837591

Case Details

VAERS ID: 837591 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2019-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Systemic lupus erythematosus
SMQs:, Systemic lupus erythematosus (narrow), 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: CO0095075131910COL000905

Write-up: LUPUS ERITEMATOSO SYNDROME; Information has been received from the Agency on 24-SEP-2019, concerning to a female patient with age reported as 16 (units not provided). The patient''s concurrent conditions, medical history and concomitant medications were not reported. On an unspecified date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown), dose reported as 4 (units not reported) (strength, frequency, route of administration, anatomical location, lot #, expiration date were not provided) as prophylaxis. On an unspecified date, the patient experienced lupus erythematous syndrome (systemic lupus erythematosus) and the outcome was fatal. It was unknown if an autopsy was performed, and the cause of death was not reported. The causal relationship between therapy with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown) and the event was not provided.

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