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This is VAERS ID 528766

History of Changes from the VAERS Wayback Machine

First Appeared on 5/16/2014

VAERS ID: 528766
VAERS Form:
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 6/14/2014

VAERS ID: 528766 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 3/14/2015

VAERS ID: 528766 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 9/14/2017

VAERS ID: 528766 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 2/14/2018

VAERS ID: 528766 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 6/14/2018

VAERS ID: 528766 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 8/14/2018

VAERS ID: 528766 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 9/14/2018

VAERS ID: 528766 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.


Changed on 10/14/2018

VAERS ID: 528766 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-04-18
Entered:2014-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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': WAES1404USA008954

Write-up: This spontaneous report was received from a registered nurse who read about the life story of a patient of unknown age on a website. On an unknown date the patient was vaccinated with GARDASIL, (dose, lot no. route not reported). On an unknown date the patient died from an unspecified cause. This is one of reports received from the same source. Additional information is not expected.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=528766&WAYBACKHISTORY=ON


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