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This is VAERS ID 387594

History of Changes from the VAERS Wayback Machine

First Appeared on 6/2/2010

VAERS ID: 387594
VAERS Form:
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 6/14/2014

VAERS ID: 387594 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 4/14/2017

VAERS ID: 387594 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 9/14/2017

VAERS ID: 387594 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 2/14/2018

VAERS ID: 387594 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 6/14/2018

VAERS ID: 387594 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 8/14/2018

VAERS ID: 387594 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 9/14/2018

VAERS ID: 387594 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.


Changed on 10/14/2018

VAERS ID: 387594 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Foreign
Vaccinated:2010-01-22
Onset:2010-04-28
Submitted:2010-05-14
Entered:2010-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-04-29
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': WAES1005USA01063

Write-up: Information has been received from a physician via the Program for Appropriate Technology concerning an 11 year old patient who on 21-JUL-2009 and 09-OCT-2009 was vaccinated with a first and second dose of GARDASIL respectively (routes, site of injection and lot numbers not reported). On 22-JAN-2010, the patient received her third dose of GARDASIL respectively (route, site of injection and lot number not reported). Subsequently, the patient died on 29-APR-2010, 96 days after the patient received her third dose. Additional information has been expected.

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