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This is VAERS ID 457904

History of Changes from the VAERS Wayback Machine

First Appeared on 7/13/2012

VAERS ID: 457904
VAERS Form:
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 457904 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 4/14/2017

VAERS ID: 457904 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 457904 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 1 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 457904 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 457904 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 457904 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 457904 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 457904 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Wisconsin
Vaccinated:2012-06-04
Onset:2012-06-07
Submitted:2012-06-21
Entered:2012-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1224AA / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Completed suicide, Death, Gun shot wound

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-07
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1206USA02932

Write-up: Information has been received from a physician concerning a 14 year old male with no pertinent medical history and no drug allergies who was vaccinated intramuscularly with the first and second 0.5ml dose of GARDASIL (Lot# not reported) respectively on 02-APR-2012 and 04-JUN-2012. There was no concomitant medication. On 07-JUN-2012 the patient committed suicide. He shot himself in head. Physician stated this young male was happy go lucky, healthy, and never had any psychiatric issues in the past. It was not known if the patient sought for medical attention. On 07-JUN-2012 the patient died of suicide. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=457904&WAYBACKHISTORY=ON


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