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This is VAERS ID 837592

Case Details

VAERS ID: 837592 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Polyneuropathy
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (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: CO0095075131910COL001082

Write-up: polyneuropathy; Information has been received from Health Authority on 20-SEP-2019. This spontaneous report has been received from a regulatory authority referring to a female patient of unknown age. No information was provided regarding the patient''s medical history, concurrent conditions, drug and allergy history or concomitant medications. On an unknown date, the patient was vaccinated with the fourth dose of human papillomavirus vaccine, unspecified 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) (strength, frequency, route of administration, lot# and expiration date were not provided)for prophylaxis. On an unknown date, the patient experienced polyneuropathy. The outcome of polyneuropathy was reported as fatal. No information was provided regarding the patient''s autopsy or the cause of death. At the reporting time, the causal relationship between the event and the suspect therapy was not reported. Upon internal review, the event polyneuropathy was determined to be medically significant.


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