National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 273426

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

273426
VAERS Form:
Age:20.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Cough, Eosinophil count, Cardiac disorder, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home"at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''''d with PALS then consulted cardiology for ECM


Changed on 12/8/2009

273426 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Cardiac disorder, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home"at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''''s VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''''d ER-resusc''d with PALS then consulted cardiology for ECM ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 7/31/2010

273426 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 4/13/2011

273426 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 5/13/2011

273426 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 6/11/2011

273426 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 3/12/2012

273426 Before After
VAERS Form:
Age:20.0 10.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 6/14/2014

273426 Before After
VAERS Form:
Age:10.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 3/14/2015

273426 Before After
VAERS Form:
Age:10.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 5/14/2017

273426 Before After
VAERS Form:
Age:10.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Eosinophil count, Mitral valve incompetence, Nasopharyngitis, Pleural effusion, Respiratory arrest, Somnolence, Tricuspid valve incompetence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


Changed on 9/14/2017

273426 Before After
VAERS Form:(blank) 1
Age:10.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-02-12
Onset:2007-03-04
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1111R / 1 2 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arrhythmia, Atrial septal defect, Cardiac arrest, Cough, Nasopharyngitis, Respiratory arrest, Somnolence, Urinary tract infection, Ventricular hypertrophy, Viral myocarditis, Vomiting, Oxygen supplementation

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Echocardiogram:dilated right ventricle. severely decreased biventricular systolic function. mild tricuspid/mitral insufficiency. atrial septum bulges. small pleural effusion right.
CDC 'Split Type':

Write-up:Vaccine administration date 2/12/2007, varicella dose #2 and Gardisil dose #1 administered concurrently. No symptoms until March 4th when in AM noted by mother to have a cold/URI symptoms with cough. Emesis at 11 after soup at 10, napping when mom at home at 3 PM but difficult to arouse. Called 911 and started rescue breathing. Paramedics initially called in stable VS''s but required active CPR on gurney by time came into ED. In disorganized vfib in ER-resusc''d with PALS then consulted cardiology for ECMO. Cannulated for VA ECMO - on full flow support after 1.5 hours. Heart completely akinetic. Went to cath lab to get biopsies, CAD''s and assessment of integrity of heart with very poor tone/strength to heart muscle noted; presumed acute viral myocarditis. Has gotten IVIG. Can''t assess neurologic function due to significant drug load. Remains with very disorganized rhythym today; to consider EPS study; also studying family for possible inherited rhythym disturbances. 03/20/07-partial records received from facility, patient remains in hospital. Received ECMO support for cardiac arrest secondary to myocarditis. Endomyocardial biopsy: acute lymphocytic myocarditis with scattered eosinophils. 04/25/07-DC Summary received for DOS 03/04-03/23/07-DC DX: Cardiac arrhythmia. Myocarditis. Per information received from annual follow up, off all CHF medications; very minimal residual orgainc brain syndrome; responding to PT/OT & counseling.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=273426&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166