This is VAERS ID 621565

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2016

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / -	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

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Changed on 9/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / - UNK	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

---

Changed on 2/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / UNK	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

---

Changed on 6/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / UNK	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

---

Changed on 8/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / UNK	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

---

Changed on 9/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / UNK	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

---

Changed on 10/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	- / UNK	- / -

Administered by: Other      Purchased by: Other
Symptoms: Death, Myocardial infarction, Pain, Seizure, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-12
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: Unknown
Current Illness: None known and date of vaccination is UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possible Lyme disease, 3 and a half years of pain with seizures and tachycardia. Seizure led to heart attack and death on 1/12/16.

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