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This is VAERS ID 453010

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/11/2012

VAERS ID: 453010
VAERS Form:
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 6/14/2014

VAERS ID: 453010 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 3/14/2015

VAERS ID: 453010 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 9/14/2017

VAERS ID: 453010 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 1 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 2/14/2018

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 6/14/2018

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 8/14/2018

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 9/14/2018

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 10/14/2018

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 12/24/2020

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 12/30/2020

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 5/7/2021

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.


Changed on 5/21/2021

VAERS ID: 453010 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Kentucky
Vaccinated:2012-03-20
Onset:2012-03-29
Submitted:2012-04-04
Entered:2012-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-29
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: Loestrin 1/20mg one daily. Cetraxal 0.2% solution 2 drops bid for 7 days
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Undetermined cause death occurred nine days after 2nd injection of Gardasil. 1st dose on 01/31/2012.

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