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This is VAERS ID 297528

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 297528
VAERS Form:
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician''''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered,"rather they were the patient''''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 12/8/2009

VAERS ID: 297528 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0711USA02619

Write-up: Information has been received from a physician''''s physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered,"rather administered, rather they were the patient''''s patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 297528 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02619

Write-up: Information has been received from a physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered, rather they were the patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 297528 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02619

Write-up: Information has been received from a physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered, rather they were the patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 297528 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02619

Write-up: Information has been received from a physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered, rather they were the patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 297528 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02619

Write-up: Information has been received from a physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered, rather they were the patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 297528 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02619

Write-up: Information has been received from a physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered, rather they were the patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 297528 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:2007-09-15
Onset:2007-10-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-10-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02619

Write-up: Information has been received from a physician''s assistant concerning a 12 year old female with no reported medical history who on approximately 15-SEP-2007 was vaccinated with Gardasil. It was noted that this was not where the vaccine was administered, rather they were the patient''s family physician. On 06-OCT-2007 the patient died in her sleep. No further information was provided. No lot number was given. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=297528&WAYBACKHISTORY=ON


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