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This is VAERS ID 611113

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2015

VAERS ID: 611113
VAERS Form:
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 611113 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 611113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 611113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 611113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 611113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 611113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-11-22
Entered:2015-11-23
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': WAES1511USA011162

Write-up: Information has been received from an unspecified reporter on a digital media via SPMSD on 18-NOV-2015, referring to a boy of unknown age. The patient''s pertinent medical history and concurrent condition were not reported. On an unknown date the patient was vaccinated with GARDASIL (lot#, expiration date, strength, dose and route were unknown). The patient''s concomitant medication was not reported. On an unknown date the patient died after vaccination. The cause of death was not reported. It was unknown if autopsy had done. The causality between the events and GARDASIL was not reported. Additional information has been requested.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=611113&WAYBACKHISTORY=ON


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