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This is VAERS ID 450655

Case Details

VAERS ID: 450655 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-02-23
Onset:0000-00-00
Submitted: 2012-02-27
Entered: 2012-02-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1495AA / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-02-26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None at time of service. Pt. expired 2-26-12.


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