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This is VAERS ID 419174

History of Changes from the VAERS Wayback Machine

First Appeared on 4/13/2011

VAERS ID: 419174
VAERS Form:
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 6/14/2014

VAERS ID: 419174 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 4/14/2017

VAERS ID: 419174 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 9/14/2017

VAERS ID: 419174 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 2/14/2018

VAERS ID: 419174 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 6/14/2018

VAERS ID: 419174 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 8/14/2018

VAERS ID: 419174 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 9/14/2018

VAERS ID: 419174 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.


Changed on 10/14/2018

VAERS ID: 419174 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2010-10-04
Onset:2010-10-07
Submitted:2011-03-18
Entered:2011-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Cough, Death, Haemoptysis, Malaise, Renal disorder, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-11-03
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1103USA00922

Write-up: Information has been received from a physician concerning a 15 year old female patient with longstanding health problems (according to mother) since childhood who on 04-OCT-2010 was vaccinated IM with a second dose of GARDASIL (Lot# not reported). In September 2010, the patient experienced cough and was sick. On 07-OCT-2010, the patient experienced cough and haemoptysis. On 30-OCT-2010, the patient was diagnosed with kidney "problem" and heart "problem". The patient was admitted to hospital. The patient''s mother cannot recall treatment or hospital ID number and had not kept files. On 03-NOV-2010, the patient died. The cause of death was not reported. Cough, sickness, haemoptysis, kidney "problem" and heart "problem" were considered to be immediately life-threatening by the reporter.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=419174&WAYBACKHISTORY=ON


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