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This is VAERS ID 393871

History of Changes from the VAERS Wayback Machine

First Appeared on 7/31/2010

VAERS ID: 393871
VAERS Form:
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 6/14/2014

VAERS ID: 393871 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 4/14/2017

VAERS ID: 393871 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 9/14/2017

VAERS ID: 393871 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 1 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 2/14/2018

VAERS ID: 393871 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 6/14/2018

VAERS ID: 393871 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 8/14/2018

VAERS ID: 393871 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 9/14/2018

VAERS ID: 393871 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.


Changed on 10/14/2018

VAERS ID: 393871 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-05-25
Onset:2010-05-28
Submitted:2010-07-28
Entered:2010-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ29430 / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Completed suicide, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-28
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: Depression
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1007USA03148

Write-up: Information has been received from the agency via a Case Line Listing via CSL, as part of a business agreement, concerning a 15 year old female patient with a history of depression who on 25-MAY-2010, was vaccinated with the second 0.5 ml IM dose of GARDASIL (batch # NK20450, lot # NJ29430). On 28-MAY-2010, within one week following vaccination, the patient experienced suicide (severe) and died. The cause of death was suicide. The agency felt that suicide was unlikely related to therapy with GARDASIL. No further information is available. A lot check has been initiated. This was originally reported by a practice nurse.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=393871&WAYBACKHISTORY=ON


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