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This is VAERS ID 325063

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 325063
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-04
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Cardiac failure congestive, Chest pain, Death, Myocarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experie"nced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this o


Changed on 12/8/2009

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-04 2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Myocarditis, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-05 2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: (blank) 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing hea
CDC 'Split Type': (blank) WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experie"nced experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this o office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 3/2/2010

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing hea
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 4/7/2010

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing hea
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 8/31/2010

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing hea
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 1/4/2011

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing hea heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 4/13/2011

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 5/13/2011

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 6/11/2011

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 6/14/2014

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 4/14/2017

VAERS ID: 325063 Before After
VAERS Form:
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Antinuclear antibody negative, Aspartate aminotransferase increased, Asthenia, Azotaemia, Blood bicarbonate decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium decreased, Blood sodium decreased, Blood thyroid stimulating hormone decreased, Blood urea increased, C-reactive protein increased, Cardiac enzymes increased, Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac abnormal, Chest pain, Chest X-ray abnormal, Chills, Death, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Hypotension, Hypoxia, Intensive care, Malaise, Myocardial infarction, Pain, Pyrexia, Respiratory distress, Shock, Tachycardia, Ventricular tachycardia, Viral myocarditis, White blood cell count increased, Ejection fraction decreased, Drug screen negative, Intra-aortic balloon placement, Brain natriuretic peptide increased, Methicillin-resistant Staphylococcus aureus test negative, Troponin increased, Myocarditis infectious, Streptococcus identification test positive, Viral cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 9/14/2017

VAERS ID: 325063 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Death, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 2/14/2018

VAERS ID: 325063 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Death, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 6/14/2018

VAERS ID: 325063 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Death, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 8/14/2018

VAERS ID: 325063 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Death, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 9/14/2018

VAERS ID: 325063 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Death, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.


Changed on 10/14/2018

VAERS ID: 325063 Before After
VAERS Form:1
Age:17.0
Sex:Female
Location:Kansas
Vaccinated:2008-07-24
Onset:2008-08-01
Submitted:2008-09-12
Entered:2008-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1740U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Chest pain, Death, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-08-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: erythromycin
Current Illness: Acne
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 10.3(H). Troponin greater than 100(H) & CPK 5492(H), CKMB 313.1(H) c/w infectious myocarditis, possibly viral. TSH 0.09(L). CRP 38.3(H). BNP 533(H). ANA neg. ASO 200(+). CXR abnormal w/water bottle appearing heart. Sodium 132(L), potassium 3.7(L), bicard 18(L), BUN 29(H), creatinine 1.3(H). AST 832(H), ALT 211(H). Urine drug screen neg. Blood c/s neg. MRSA screen neg.
CDC 'Split Type': WAES0809USA00837

Write-up: Information has been received from a physician concerning a 17 year old female with acne who on 24-JUL-2008 was vaccinated with the first dose of GARDASIL. Concomitant therapy included erythromycin, solution, topical. On 04-AUG-2008, the patient experienced abdominal pain, chest pain and aching everywhere and was hospitalized. On 05-AUG-2008, the patient experienced myocarditis and died. Diagnosis was myocarditis but the doctor said it was not related to GARDASIL. The last time she was seen in this office was 2005. No additional information at this time. Additional information has been requested. 10/01/08 Death certificate states COD as myocarditis & CHF as contributing factor. 9/22/08 Reviewed PCP medical records. Reveals patient experienced abdominal pain, chest pain & aching everywhere. Expired 8/5/08 w/viral infection of the heart. Concomitant med was erythomycin topical solution for acne. Patient noted to be in good health on day of vaccination. 4/2/09 Received hospital medical records for 8/3-8/4/2008. FINAL DX: deceased secondary to severe nonischemic cardiomyopathy secondary to viral myocarditis Records reveal patient experienced fever, chills, feeling unwell x 2-4 days. Presented to ER w/abdominal & chest pain, weakness, dizziness, hypotensive, tachycardia, SOB, respiratory distress w/hypoxemia, azotemia, shocklike symptoms. EKG w/diffuse ST changes & ST elevations. Dx w/acute anteroseptal MI Emergent cardiac cath revealed EF 23% & balloon pump placed. Intensive care, deteriorated, V-tach, decompensation, extensive resuscitation efforts failed.

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