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This is VAERS ID 615613

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2016

VAERS ID: 615613
VAERS Form:
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 615613 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 615613 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 615613 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 615613 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 615613 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 615613 Before After
VAERS Form:1
Age:12.0
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-18
Entered:2015-12-18
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': WAES1512USA007913

Write-up: This spontaneous report as received from a consumer refers to a 12 year old patient of unknown gender. The patient''s medical history, concurrent condition and concomitant medication were not reported. The reporter stated that he had seen a video on the website about a year ago, saying that a patient was vaccinated with a dose of GARDASIL (formulation, strength, dose, lot number and expiry date were not reported) (date of vaccination was not reported). On an unknown date, a week after vaccination (reported as a week after) the patient died. Product quality complaint (PQC) was not involved. The relatedness between the event and GARDASIL was not reported. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=615613&WAYBACKHISTORY=ON


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