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This is VAERS ID 450655

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2012

VAERS ID: 450655
VAERS Form:
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 6/14/2014

VAERS ID: 450655 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 3/14/2015

VAERS ID: 450655 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 9/14/2017

VAERS ID: 450655 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 1 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 2 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 2/14/2018

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 6/14/2018

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 8/14/2018

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 9/14/2018

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 10/14/2018

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 12/24/2020

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 12/30/2020

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 5/7/2021

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.


Changed on 5/21/2021

VAERS ID: 450655 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Michigan
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted:2012-02-27
Entered:2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-26
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None at time of service. Pt. expired 2-26-12.

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