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This is VAERS ID 591496

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2015

VAERS ID: 591496
VAERS Form:
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 591496 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 591496 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 591496 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 591496 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 591496 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 591496 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-08-25
Entered:2015-08-25
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:0000-00-00
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': WAES1508USA009285

Write-up: This spontaneous report as received from a physician via company representative refers to a 12 year old patient of unknown gender. On an unknown date, the patient was vaccinated with GARDASIL (dose, lot# and route of administration was not reported). No concomitant medication was reported. The physician stated that unspecified person watched television show which reported that on an unknown date the patient died after receiving GARDASIL. Causality assessment was not provided. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=591496&WAYBACKHISTORY=ON


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