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This is VAERS ID 540269

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2014

VAERS ID: 540269
VAERS Form:
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.


Changed on 9/14/2017

VAERS ID: 540269 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.


Changed on 2/14/2018

VAERS ID: 540269 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.


Changed on 6/14/2018

VAERS ID: 540269 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.


Changed on 8/14/2018

VAERS ID: 540269 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.


Changed on 9/14/2018

VAERS ID: 540269 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.


Changed on 10/14/2018

VAERS ID: 540269 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Arizona
Vaccinated:0000-00-00
Onset:2014-07-31
Submitted:2014-08-19
Entered:2014-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-07-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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': WAES1408USA010190

Write-up: This spontaneous report as received from a physician via a company representative refers to a 12 year old female patient. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, dose, route not reported). Concomitant medications were not provided. The physician reported that she read a report, possibly online, about the patient who had a seizure on an unknown date after administration of GARDASIL and died on 31-JUL-2014. The cause of death was unspecified. The patient had sought unspecified medical attention. Outcome of seizure was unknown. Causality was not provided. Upon internal review, seizure was determined to be medically significant. Additional information is not expected because the reporter did not want to be contacted.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=540269&WAYBACKHISTORY=ON


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