National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 275428

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

275428
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-01
Onset:2007-03-07
Submitted:2007-04-02
Entered:2007-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0943R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Acidosis, Alanine aminotransferase increased, Aspartate aminotransferase increased, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-03-08
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: aortic and mitral valve insufficiency, unknown aetiology
Allergies:
Diagnostic Lab Data: ER LABS of 3/8/07: ABG pH 7.23, po2 62. Serum glucose 353, Creat 1.7, albumin 2.6, total protein 4.9, SGPT 62, SGOT 359. Blood c/s was neg. 2005 Cardiology LABS: echocardiogram revealed mild mitral valve & aortic valve insufficiency. Mi
CDC 'Split Type':

Write-up:presented to ED with Ventricular tachycardia. Preliminary autopsy finding of myocarditis


Changed on 12/8/2009

275428 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-01
Onset:2007-03-07
Submitted:2007-04-02
Entered:2007-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0943R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Acidosis, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood creatinine increased, Blood culture negative, Blood gases abnormal, Blood glucose increased, Cardiomegaly, Chest X-ray abnormal, Cough, Gastroenteritis, Mitral valve incompetence, Myocarditis, Nervousness, Oxygen saturation decreased, Palpitations, Protein total decreased, Pyrexia, Rhinorrhoea, Ventricular tachycardia, Viral myocarditis, Autopsy, Echocardiogram abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-03-08
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: aortic and mitral valve insufficiency, unknown aetiology
Allergies:
Diagnostic Lab Data: ER LABS of 3/8/07: ABG pH 7.23, po2 62. Serum glucose 353, Creat 1.7, albumin 2.6, total protein 4.9, SGPT 62, SGOT 359. Blood c/s was neg. 2005 Cardiology LABS: echocardiogram revealed mild mitral valve & aortic valve insufficiency. Mi
CDC 'Split Type':

Write-up:presented to ED with Ventricular tachycardia. Preliminary autopsy finding of myocarditis. 4/3/07 Spoke w/ME who stated prelim COD as acute myocarditis, presumably viral. States patient had PMH of heart murmur which was evaluated by ped cardiologist who found mild aortic & mitral valve insufficiency & regurgitation. ME states did not see evidence of that on autopsy but did find cardiomegaly. Also states patient had been taken to ER on day of death for abdominal pain w/fever & was dx w/gastroenteritis. CXR at that time revealed cardiomegaly. No EKG or cultures were done. Was d/c to home & continued to not feel well. Parent found patient in bathroom unresponsive at approx 2AM & was transported to a second ER where she expired. ME states patient had approx 2 week hx of cough & runny nose prior to death. 6/12/07 Received final Autopsy Report which reveals COD as acute probable viral etiology myocarditis & manner of death as natural. 6/29/07 Received ER records from hospital where patient expired which reveal patient was in respiratory arrest & had been intubated by EMS. ACLS measures were unsuccessful & patient pronounced. 8/24/07 Received cardiology consult which reveals patient evaluated for heart murmur in 2005 which had been diagnosed for long time but never evaluated. Patient admitted to palpitations & nervousness. Patient history did not reveal any evidence of rheumatic fever. Antibiotic endocarditis prophylaxis recommended prior to dental & surgical procedures. Patient was to f/u w/cardiology in 2-3 yearrs to document progress of valvular insufficiency. FINAL Cardiology DX: Aortic & mitral valve insufficiency of unknown etiology.


Changed on 5/14/2017

275428 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-01
Onset:2007-03-07
Submitted:2007-04-02
Entered:2007-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0943R / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Acidosis, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood creatinine increased, Blood culture negative, Blood gases abnormal, Blood glucose increased, Cardiomegaly, Chest X-ray abnormal, Cough, Gastroenteritis, Mitral valve incompetence, Myocarditis, Nervousness, Oxygen saturation decreased, Palpitations, Protein total decreased, Pyrexia, Rhinorrhoea, Ventricular tachycardia, Viral myocarditis, Autopsy, Echocardiogram abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-03-08
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: aortic and mitral valve insufficiency, unknown aetiology
Allergies:
Diagnostic Lab Data: ER LABS of 3/8/07: ABG pH 7.23, po2 62. Serum glucose 353, Creat 1.7, albumin 2.6, total protein 4.9, SGPT 62, SGOT 359. Blood c/s was neg. 2005 Cardiology LABS: echocardiogram revealed mild mitral valve & aortic valve insufficiency. Mi Mitral valve leaflets were slightly thickened.
CDC 'Split Type':

Write-up:presented to ED with Ventricular tachycardia. Preliminary autopsy finding of myocarditis. 4/3/07 Spoke w/ME who stated prelim COD as acute myocarditis, presumably viral. States patient had PMH of heart murmur which was evaluated by ped cardiologist who found mild aortic & mitral valve insufficiency & regurgitation. ME states did not see evidence of that on autopsy but did find cardiomegaly. Also states patient had been taken to ER on day of death for abdominal pain w/fever & was dx w/gastroenteritis. CXR at that time revealed cardiomegaly. No EKG or cultures were done. Was d/c to home & continued to not feel well. Parent found patient in bathroom unresponsive at approx 2AM & was transported to a second ER where she expired. ME states patient had approx 2 week hx of cough & runny nose prior to death. 6/12/07 Received final Autopsy Report which reveals COD as acute probable viral etiology myocarditis & manner of death as natural. 6/29/07 Received ER records from hospital where patient expired which reveal patient was in respiratory arrest & had been intubated by EMS. ACLS measures were unsuccessful & patient pronounced. 8/24/07 Received cardiology consult which reveals patient evaluated for heart murmur in 2005 which had been diagnosed for long time but never evaluated. Patient admitted to palpitations & nervousness. Patient history did not reveal any evidence of rheumatic fever. Antibiotic endocarditis prophylaxis recommended prior to dental & surgical procedures. Patient was to f/u w/cardiology in 2-3 yearrs to document progress of valvular insufficiency. FINAL Cardiology DX: Aortic & mitral valve insufficiency of unknown etiology.


Changed on 9/14/2017

275428 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-01
Onset:2007-03-07
Submitted:2007-04-02
Entered:2007-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 1 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0943R / 1 2 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Ventricular tachycardia, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-03-08
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: aortic and mitral valve insufficiency, unknown aetiology
Allergies:
Diagnostic Lab Data: ER LABS of 3/8/07: ABG pH 7.23, po2 62. Serum glucose 353, Creat 1.7, albumin 2.6, total protein 4.9, SGPT 62, SGOT 359. Blood c/s was neg. 2005 Cardiology LABS: echocardiogram revealed mild mitral valve & aortic valve insufficiency. Mitral valve leaflets were slightly thickened.
CDC 'Split Type':

Write-up:presented to ED with Ventricular tachycardia. Preliminary autopsy finding of myocarditis. 4/3/07 Spoke w/ME who stated prelim COD as acute myocarditis, presumably viral. States patient had PMH of heart murmur which was evaluated by ped cardiologist who found mild aortic & mitral valve insufficiency & regurgitation. ME states did not see evidence of that on autopsy but did find cardiomegaly. Also states patient had been taken to ER on day of death for abdominal pain w/fever & was dx w/gastroenteritis. CXR at that time revealed cardiomegaly. No EKG or cultures were done. Was d/c to home & continued to not feel well. Parent found patient in bathroom unresponsive at approx 2AM & was transported to a second ER where she expired. ME states patient had approx 2 week hx of cough & runny nose prior to death. 6/12/07 Received final Autopsy Report which reveals COD as acute probable viral etiology myocarditis & manner of death as natural. 6/29/07 Received ER records from hospital where patient expired which reveal patient was in respiratory arrest & had been intubated by EMS. ACLS measures were unsuccessful & patient pronounced. 8/24/07 Received cardiology consult which reveals patient evaluated for heart murmur in 2005 which had been diagnosed for long time but never evaluated. Patient admitted to palpitations & nervousness. Patient history did not reveal any evidence of rheumatic fever. Antibiotic endocarditis prophylaxis recommended prior to dental & surgical procedures. Patient was to f/u w/cardiology in 2-3 yearrs to document progress of valvular insufficiency. FINAL Cardiology DX: Aortic & mitral valve insufficiency of unknown etiology.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=275428&WAYBACKHISTORY=ON


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