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This is VAERS ID 379876

History of Changes from the VAERS Wayback Machine

First Appeared on 3/2/2010

VAERS ID: 379876
VAERS Form:
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 6/14/2014

VAERS ID: 379876 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 4/14/2017

VAERS ID: 379876 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 9/14/2017

VAERS ID: 379876 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 2/14/2018

VAERS ID: 379876 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 6/14/2018

VAERS ID: 379876 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 8/14/2018

VAERS ID: 379876 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 9/14/2018

VAERS ID: 379876 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.


Changed on 10/14/2018

VAERS ID: 379876 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-19
Onset:2010-01-21
Submitted:2010-02-08
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Poisoning deliberate, General physical health deterioration

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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1002USA00379

Write-up: Information has been received from a physician concerning a 13 year old school going girl (ID#: -104/09) of class eight. On 19-JUL-2009, patient received first dose of GARDASIL left deltoid (lot#876, manufacturing date June 2008). Patient successfully completed her second dose on 13-OCT-2009. She was due with her third dose. On 21-JAN-2010, she was reported to have consumed poison around 9:00 am. She was taken to the area hospital and provided preliminary emergency treatment. She was provided DECADRON injection 2 cc, injection dopamine 1 amp. in 5% dextrose 10-12 drops/min, injection deriphylline I.V 8 hourly, injection diazepam 1 amp. IV, Ryle''s tube aspiration and stomach wash. It was advised to record her temperature, pulse, respiration, and blood pressure half hourly and had oxygen inhalation. High risk consent was taken. As her condition started to deteriorate she was shifted to another hospital by ''108 emergency service'' for further evaluation and management. On the way to the hospital, it was reported to have expired around 2:00 pm on 21-JAN-2010. The hospital noted the case was "brought dead". The postmortem was performed on 22-JAN-2010 and the results are awaited. The medical officer in charge investigated the death and completed first information report and determined the death could be suicide (due to poison intake) and not related to the vaccine. This report was part of a post-marketing surveillance program.

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