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This is VAERS ID 621565

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2016

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.

Changed on 9/14/2017

VAERS ID: 621565 Before After
VAERS Form:(blank) 1
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. - / - 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

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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 12/24/2020

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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 12/30/2020

VAERS ID: 621565 Before After
VAERS Form:1
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. - / 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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=621565&WAYBACKHISTORY=ON


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