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This is VAERS ID 570801

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2015

VAERS ID: 570801
VAERS Form:
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.


Changed on 9/14/2017

VAERS ID: 570801 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.


Changed on 2/14/2018

VAERS ID: 570801 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.


Changed on 6/14/2018

VAERS ID: 570801 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.


Changed on 8/14/2018

VAERS ID: 570801 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.


Changed on 9/14/2018

VAERS ID: 570801 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.


Changed on 10/14/2018

VAERS ID: 570801 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Unknown
Vaccinated:2013-06-01
Onset:2014-10-10
Submitted:2015-03-22
Entered:2015-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK AR / SYR

Administered by: Unknown      Purchased by: Private
Symptoms: Death, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-10-11
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Syncope. Died at ER.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=570801&WAYBACKHISTORY=ON


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