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This is VAERS ID 575160

History of Changes from the VAERS Wayback Machine

First Appeared on 6/13/2015

VAERS ID: 575160
VAERS Form:
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 575160 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 575160 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 575160 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 575160 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 575160 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 575160 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:2015-02-16
Submitted:2015-02-20
Entered:2015-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Myalgia, Pyrexia, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-02-20
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': WAES1502COL009207

Write-up: This spontaneous report as received from the patient''s parent (also reported as a friend of the mother''s patient) via a social webpage refers to a 16 year old female patient. In June 2013, the patient was vaccinated with a dose of GARDASIL (dose and lot # not reported) intramuscularly. In March 2014, the patient experienced fever, muscular pain and other symptoms (not specified) that the physician could not control, no diagnosis was done. The consumer also reported that on 16-FEB-2015, the patient experienced respiratory arrest and died. The outcome of fever and muscular pain was reported as not recovered/not resolved. The relationship between the events and GARDASIL was not reported. Upon internal review respiratory arrest was considered to be medically signfiicant. Additional information has been requested.

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