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This is VAERS ID 541912

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2014

VAERS ID: 541912
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 541912 Before After
VAERS Form:(blank) 1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 541912 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 541912 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 541912 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 541912 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 541912 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-27
Submitted:2014-09-01
Entered:2014-09-01
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:2014-08-27
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': WAES1408USA016953

Write-up: This spontaneous report as received from a physician via company representative via on-line document (social media) (source unspecified) refers to an 11 or 12 year old female patient. Pertinent medical history, drug reactions or allergies were not reported. On an unknown date the patient was vaccinated with GARDASIL (strength, dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were unspecified). No concomitant therapies were reported. On 27-AUG-2014 the 11 or 12 year old female died after receiving GARDASIL. At the time of this report it was not known if an autopsy were performed. The outcome of the event was reported as fatal. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=541912&WAYBACKHISTORY=ON


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