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This is VAERS ID 380081

History of Changes from the VAERS Wayback Machine

First Appeared on 3/2/2010

VAERS ID: 380081
VAERS Form:
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 6/14/2014

VAERS ID: 380081 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 4/14/2017

VAERS ID: 380081 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 9/14/2017

VAERS ID: 380081 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 2/14/2018

VAERS ID: 380081 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 6/14/2018

VAERS ID: 380081 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 8/14/2018

VAERS ID: 380081 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 9/14/2018

VAERS ID: 380081 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.


Changed on 10/14/2018

VAERS ID: 380081 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Foreign
Vaccinated:2009-07-17
Onset:2009-08-08
Submitted:2010-02-05
Entered:2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Death, Dyspnoea, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-08-08
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: RANTAC; acetaminophen, aminophylline; chloroquine
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1001USA03765

Write-up: Information has been received from a physician concerning a 13 year old school girl studying in class nine of health center. On 17-JUL-2009, patient received first dose of GARDASIL left deltoid. Concomitant medications included chloroquine, RANTAC, paracetamol, "IV fluids RL" and aminophyline drip. During the process of community mobilization for second dose of GARDASIL the multipurpose health worker was informed that the patient developed fever on 01-AUG-2009 and was treated by local registered medical practitioner (RMP). The patient did not recover and was admitted to the hospital on 08-AUG-2009. On the same day, GENTAMYCIN was given. She developed dyspnoea and went into coma and so was referred and was shifted to another hospital where she expired on 08-AUG-2009 at around 9:00 pm. The cause of death was determined as "death due to viral fever". The information was provided from patient''s maternal grandparents as she was staying with them. This event occurred after 23 days of receiving first dose of GARDASIL. The female health worker informed the medical officer in charge and he investigated the death and completed the first information report as per AEFI guidelines. The case sheet mentions as "pyrexia of unknown origin". This information was then communicated to district immunization officer, who determined that the death was not related to the vaccine and so a decision was taken to close the investigation.

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