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This is VAERS ID 743123

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2018

VAERS ID: 743123
VAERS Form:2
Age:11.0
Sex:Female
Location:California
Vaccinated:2018-02-08
Onset:2018-02-11
Submitted:0000-00-00
Entered:2018-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N026812 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M17013 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5563AA / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Influenza, Respiratory distress, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: vaginal itching
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received immunizations on 2/8/18. She presented to ED on 2/11/18 in respiratory distress/ septic shock and passed away the same day, presumably from Influenza B.


Changed on 6/14/2018

VAERS ID: 743123 Before After
VAERS Form:2
Age:11.0
Sex:Female
Location:California
Vaccinated:2018-02-08
Onset:2018-02-11
Submitted:0000-00-00
Entered:2018-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N026812 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M17013 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5563AA / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Influenza, Respiratory distress, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: vaginal itching
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received immunizations on 2/8/18. She presented to ED on 2/11/18 in respiratory distress/ septic shock and passed away the same day, presumably from Influenza B.


Changed on 8/14/2018

VAERS ID: 743123 Before After
VAERS Form:2
Age:11.0
Sex:Female
Location:California
Vaccinated:2018-02-08
Onset:2018-02-11
Submitted:0000-00-00
Entered:2018-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N026812 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M17013 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5563AA / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Influenza, Respiratory distress, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: vaginal itching
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received immunizations on 2/8/18. She presented to ED on 2/11/18 in respiratory distress/ septic shock and passed away the same day, presumably from Influenza B.


Changed on 9/14/2018

VAERS ID: 743123 Before After
VAERS Form:2
Age:11.0
Sex:Female
Location:California
Vaccinated:2018-02-08
Onset:2018-02-11
Submitted:0000-00-00
Entered:2018-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N026812 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M17013 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5563AA / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Influenza, Respiratory distress, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: vaginal itching
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received immunizations on 2/8/18. She presented to ED on 2/11/18 in respiratory distress/ septic shock and passed away the same day, presumably from Influenza B.


Changed on 10/14/2018

VAERS ID: 743123 Before After
VAERS Form:2
Age:11.0
Sex:Female
Location:California
Vaccinated:2018-02-08
Onset:2018-02-11
Submitted:0000-00-00
Entered:2018-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N026812 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M17013 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5563AA / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Influenza, Respiratory distress, Septic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: vaginal itching
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received immunizations on 2/8/18. She presented to ED on 2/11/18 in respiratory distress/ septic shock and passed away the same day, presumably from Influenza B.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=743123&WAYBACKHISTORY=ON


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