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This is VAERS ID 541916

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2014

VAERS ID: 541916
VAERS Form:
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 541916 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 541916 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 541916 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 541916 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 541916 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 541916 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2014-08-19
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:2014-08-19
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA013464

Write-up: This spontaneous report was received from a consumer who read an article on the internet refers to a 12 year old female patient. No medical history reported. On an unknown date, same day or day after they took her home the patient was vaccinated with GARDASIL (dose number and route of administration unknown) (lot number unknown). No concomitant therapies reported. On 19-AUG-2014 the patient went to bed and didn''t wake up (death). The patient died on 19-AUG-2014. The cause of death according to the consumer was reported as GARDASIL. The causality was unknown. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=541916&WAYBACKHISTORY=ON


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