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This is VAERS ID 513728

History of Changes from the VAERS Wayback Machine

First Appeared on 12/13/2013

VAERS ID: 513728
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 513728 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 3/14/2015

VAERS ID: 513728 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 513728 Before After
VAERS Form:(blank) 1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 513728 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 513728 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 513728 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 513728 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 513728 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2013-11-19
Entered:2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311USA007759

Write-up: This spontaneous report as received from a consumer (patients mother) via an unspecified person from an Immunization Coalition and company representative refers to a female patient of unknown age. No information regarding the patients medical history was provided. On an unknown date the patient was vaccinated with GARDASIL injection. Dose and route of administration were not provided. No concomitant medication was reported. In the email from the Immunization Coalition was stated that an unspecified mother claimed that her daughter died in 2008 as a result of GARDASIL. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=513728&WAYBACKHISTORY=ON


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