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History of Changes from the VAERS Wayback Machine |
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=375036&WAYBACKHISTORY=ON
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