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This is VAERS ID 634742

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2016

VAERS ID: 634742
VAERS Form:
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 634742 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 634742 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 634742 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 634742 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 634742 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 634742 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-05-06
Entered:2016-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Syncope

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': WAES1605USA003129

Write-up: This spontaneous report was received from a consumer referring to a young patient of unknown age and gender. The patient''s pertinent medical history and concurrent conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL (anatomical route of vaccination, lot number and expiration date were not provided). The patient''s concomitant medications were not reported. The reported stated, that after watching TV news, heard about a young child who collapsed and died after receiving GARDASIL. At the time of the report, the outcome was reported as fatal. Relatedness between the adverse event and vaccination with GARDASIL was not provided. This is one of several cases received from the same source. MARRS: 1605USA003026. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=634742&WAYBACKHISTORY=ON


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