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This is VAERS ID 526687

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2014

VAERS ID: 526687
VAERS Form:
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 5/16/2014

VAERS ID: 526687 Before After
VAERS Form:
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 0 UN / UN
SMALL: SMALLPOX (NO BRAND NAME) SMALLPOX (ACAM2000) / UNKNOWN MANUFACTURER SANOFI PASTEUR - WV04003A / - 0 - UN / -

Administered by: Military      Purchased by: Military
Symptoms: Blood immunoglobulin M increased, Cardiomegaly, Eosinophilic myocarditis, Myocarditis, Rhinitis allergic, Skin papilloma, Sudden death, Left ventricular hypertrophy, Excoriation, Toxicologic test abnormal, Toxicologic test, Histology abnormal, Orthopoxvirus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 6/14/2014

VAERS ID: 526687 Before After
VAERS Form:
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 0 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 0 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Blood immunoglobulin M increased, Cardiomegaly, Eosinophilic myocarditis, Myocarditis, Rhinitis allergic, Skin papilloma, Sudden death, Left ventricular hypertrophy, Excoriation, Toxicologic test abnormal, Toxicologic test, Histology abnormal, Orthopoxvirus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 3/14/2015

VAERS ID: 526687 Before After
VAERS Form:
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 0 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 0 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Blood immunoglobulin M increased, Cardiomegaly, Eosinophilic myocarditis, Myocarditis, Rhinitis allergic, Skin papilloma, Sudden death, Left ventricular hypertrophy, Excoriation, Toxicologic test abnormal, Toxicologic test, Histology abnormal, Orthopoxvirus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 9/14/2017

VAERS ID: 526687 Before After
VAERS Form:(blank) 1
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 0 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 0 1 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 2/14/2018

VAERS ID: 526687 Before After
VAERS Form:1
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 1 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 6/14/2018

VAERS ID: 526687 Before After
VAERS Form:1
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 1 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 8/14/2018

VAERS ID: 526687 Before After
VAERS Form:1
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 1 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 9/14/2018

VAERS ID: 526687 Before After
VAERS Form:1
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 1 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


Changed on 10/14/2018

VAERS ID: 526687 Before After
VAERS Form:1
Age:24.0
Sex:Male
Location:Unknown
Vaccinated:2014-03-07
Onset:2014-03-19
Submitted:2014-03-25
Entered:2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 1 UN / -

Administered by: Military      Purchased by: Military
Symptoms: Cardiomegaly, Myocarditis, Sudden death, Toxicologic test, Histology abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-03-19
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: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC 'Split Type':

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=526687&WAYBACKHISTORY=ON


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