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This is VAERS ID 538295

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2014

VAERS ID: 538295
VAERS Form:
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 0 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.


Changed on 9/14/2017

VAERS ID: 538295 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 0 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.


Changed on 2/14/2018

VAERS ID: 538295 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.


Changed on 6/14/2018

VAERS ID: 538295 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.


Changed on 8/14/2018

VAERS ID: 538295 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.


Changed on 9/14/2018

VAERS ID: 538295 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.


Changed on 10/14/2018

VAERS ID: 538295 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Wisconsin
Vaccinated:2014-07-30
Onset:2014-07-30
Submitted:2014-07-31
Entered:2014-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-30
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: Albuterol
Current Illness: Complaints of mild sore throat, but no objective signs of illness
Preexisting Conditions: Exercise induced asthma, dust allergy, intermittent asthma, ADHD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiorespiratory arrest and death.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=538295&WAYBACKHISTORY=ON


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