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This is VAERS ID 379570

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 379570
VAERS Form:
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 6/14/2014

VAERS ID: 379570 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 4/14/2017

VAERS ID: 379570 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 9/14/2017

VAERS ID: 379570 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 2/14/2018

VAERS ID: 379570 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 6/14/2018

VAERS ID: 379570 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 8/14/2018

VAERS ID: 379570 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 9/14/2018

VAERS ID: 379570 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.


Changed on 10/14/2018

VAERS ID: 379570 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-20
Onset:2009-09-06
Submitted:2010-02-04
Entered:2010-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drowning, Fall

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=379570&WAYBACKHISTORY=ON


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