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This is VAERS ID 510130

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2013

VAERS ID: 510130
VAERS Form:
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 6/14/2014

VAERS ID: 510130 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 3/14/2015

VAERS ID: 510130 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 9/14/2017

VAERS ID: 510130 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 1 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 2/14/2018

VAERS ID: 510130 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 6/14/2018

VAERS ID: 510130 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 8/14/2018

VAERS ID: 510130 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 9/14/2018

VAERS ID: 510130 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.


Changed on 10/14/2018

VAERS ID: 510130 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:California
Vaccinated:2013-08-19
Onset:2013-08-20
Submitted:2013-10-26
Entered:2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020062 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Death, Myocarditis, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-08-20
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: Autopsy.
CDC 'Split Type':

Write-up: Victim was found unresponsive/cardiac arrest in bed at home in the morning of 8/20/13. Autopsy showed cause of death was myocarditis.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=510130&WAYBACKHISTORY=ON


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