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This is VAERS ID 375036

History of Changes from the VAERS Wayback Machine

First Appeared on 1/5/2010

VAERS ID: 375036
VAERS Form:
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 375036 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 0 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 375036 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 375036 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 375036 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 375036 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 375036 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2007-05-22
Onset:2007-07-11
Submitted:2009-12-23
Entered:2009-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0859F / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Osteitis, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-07-15
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: VALETTE
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA02946

Write-up: Information has been received from a physician concerning a previous healthy 17 year old female patient with no relevant medical history who on 22-MAY was vaccinated intramuscularly with her first dose of GARDASIL (Lot # 654740/0859F) (Batch # NE29660) (Injection site was not reported). Concomitant therapy included VALETTE. On 11-JUL-2007 the reporter was informed by the patient''s mother that her daughter was hospitalized due to bone inflammation. On 15-JUL-2007, approximately 7 weeks post vaccination, the patient died of unknown cause. An autopsy was carried out, but the result was not known to the reporter up to the time of reporting. A lot check has been initiated. Other business partner numbers include E2009-11667. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=375036&WAYBACKHISTORY=ON


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