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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 621565 |
VAERS Form: | |
Age: | 15.0 |
Sex: | Female |
Location: | Georgia |
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Vaccinated: | 0000-00-00 |
Onset: | 2012-01-01 |
Submitted: | 2016-02-02 |
Entered: | 2016-02-02 |
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.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=621565&WAYBACKHISTORY=ON
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