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This is VAERS ID 372910

History of Changes from the VAERS Wayback Machine

First Appeared on 1/5/2010

VAERS ID: 372910
VAERS Form:
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2009-03-17
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1283U / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.


Changed on 9/14/2017

VAERS ID: 372910 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2009-03-17
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1283U / 2 3 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.


Changed on 2/14/2018

VAERS ID: 372910 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2009-03-17 2008-09-18
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1283U - / 3 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.


Changed on 6/14/2018

VAERS ID: 372910 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2008-09-18
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.


Changed on 8/14/2018

VAERS ID: 372910 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2008-09-18
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.


Changed on 9/14/2018

VAERS ID: 372910 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2008-09-18
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.


Changed on 10/14/2018

VAERS ID: 372910 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Foreign
Vaccinated:2008-09-18
Onset:2009-09-22
Submitted:2009-12-10
Entered:2009-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-09-22
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: Herpes virus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00953

Write-up: Information has been received from the agency via Case Line listing via CSL, as part of a business agreement, concerning an 18 year old female patient with disseminated herpes viral disease who on 17-MAR-2009 was vaccinated with the third dose of GARDASIL (batch #NJ11440, lot# 1283U). The second suspect therapy included DEPO-PROVERA which was administered IM, 600 mg yearly, from 2007 October to 2009 January. On 22-SEP-2009 the patient developed sudden death (severe). It was unknown if the patient sought medical attention. A lot check has been initiated. No further information is available.

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