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This is VAERS ID 691836

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2017

VAERS ID: 691836
VAERS Form:
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 0 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 1 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.


Changed on 9/14/2017

VAERS ID: 691836 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 0 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 1 2 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.


Changed on 2/14/2018

VAERS ID: 691836 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 2 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.


Changed on 6/14/2018

VAERS ID: 691836 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 2 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.


Changed on 8/14/2018

VAERS ID: 691836 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 2 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.


Changed on 9/14/2018

VAERS ID: 691836 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 2 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.


Changed on 10/14/2018

VAERS ID: 691836 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Colorado
Vaccinated:2011-07-08
Onset:2011-07-28
Submitted:2017-04-25
Entered:2017-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181AA / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U3514AA / 2 AR / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Autopsy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-07-28
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy determined unknown cause of death
CDC 'Split Type':

Write-up: Layed down to take a nap and never woke up.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=691836&WAYBACKHISTORY=ON


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