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This is VAERS ID 319810
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| VAERS ID: | 319810 | Vaccinated: | 2007-08-06 | | Age: | 15.0 | Onset: | 2007-09-20, Days after vaccination: 45 | | Gender: | Female | Submitted: | 2008-07-18, Days after onset: 302 | | Location: | Illinois | Entered: | 2008-07-21, Days after submission: 3 | |
| Life Threatening Illness? Yes |
Died? Yes
Date died: 2007-09-20
Days after onset: 0 |
| Disability? Yes |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: Unknown. Labs and Diagnostics: Tox screen (-). | | Previous Vaccinations: | | Other Medications: Unknown | | Preexisting Conditions: Unknown. PMH: 1 prior seizure 8/2007. 4/28/09 Additional records received from PCP at CDC's request. Pt in for OV 1/30/07 with c/o allergy sx and requesting HPV#1-given 0012U. Returned 3/22/07 for HPV#2-given 1427F with Boostrix AC52B012AA. Mild URI 4/25/07. OV 6/12/07 in F/U to ER visit for seizure on 6/11/07. Syncope noted. Sent for tests. OV 6/28/07 Echo and blood work repor | | CDC 'Split Type': WAES0807USA02139 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0012U | 2 | UN | UN | |
| Administered by: Other Purchased by: Other | | Symptoms: Cardiac arrest, Convulsion, Death, Fall, Mydriasis, Pulmonary congestion, Pulmonary oedema, Pulse absent, Pupil fixed, Respiration abnormal, Syncope, Toxicologic test normal, Unresponsive to stimuli, Ventricular fibrillation, Visceral congestion | | Write-up: Information has been received from a certified medical assistant concerning a 14 year old female who was vaccinated with a first dose of GARDASIL and experienced syncope. She was taken to an emergency room and released. The patient was vaccinated with a second dose of GARDASIL (unspecified time). Subsequently, the patient experienced her first seizure (unspecified time) and was taken to the emergency room (no further details provided). The patient was vaccinated with a third dose of GARDASIL at 15 years old. Approximately 27-JUN-2008, two weeks after the third dose, the patient developed a complication. She was taken to the hospital by ambulance but passed away during the transport from an unknown cause. The physician has asked the mother for the autopsy report. The reporting medical assistant considered the syncope, seizure and "a complication" were considered to be immediately life-threatening and disabling. Additional information has been requested. 2/13/09 Autopsy report received. COD: Seizure Disorder. Summary Diagnoses: Clinical history of seizure disorder. Pulmonary congestion and edema. Passive visceral congestion. 2/20/2009 ER received from CDC. Pt presented to ER via EMS following witnessed seizure activity with fall from standing. Upon EMS arrival pt had agonal respirations and was pulseless in V-fib at 650. Upon arrival in ER unresponsive, pupils fixed and dilated, no cardiac activity. Resuscitation unsuccessful and pt expired. |
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Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=319810
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