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This is VAERS ID 344160

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 344160
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP a
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albu
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 3/2/2010

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP a
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albu
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 4/7/2010

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP a
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albu
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 1/4/2011

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP a and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albu Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 4/13/2011

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 5/13/2011

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 6/11/2011

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 2/14/2017

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aldolase increased, Anion gap increased, Arthralgia, Aspartate aminotransferase increased, Blood albumin decreased, Blood chloride decreased, Blood creatine phosphokinase normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood potassium decreased, Blood sodium decreased, Carbon dioxide decreased, Chest X-ray abnormal, Culture urine positive, Death, Full blood count, Globulins increased, Glucose urine, Haematocrit normal, Haemoglobin normal, Hypotension, Immunisation reaction, Infective myositis, Mean cell haemoglobin decreased, Mean cell volume decreased, Myalgia, Nausea, Necrotising fasciitis, Oedema peripheral, Pain, Pain in extremity, Pyrexia, Rash, Resuscitation, Septic shock, Sleep disorder, Tenderness, Viral infection, Vomiting, White blood cell count increased, Abasia, Streptococcal bacteraemia, Haemodynamic instability, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage decreased, Urobilin urine present, Band neutrophil percentage increased, Bacterial infection, Blood test abnormal, Abnormal behaviour, Red blood cell abnormality, Urine analysis normal, Streptococcus identification test positive, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 4/14/2017

VAERS ID: 344160 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock. (1812 vs. 1811 characters long)


Changed on 9/14/2017

VAERS ID: 344160 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 0 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 0 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 0 1 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 0 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 2/14/2018

VAERS ID: 344160 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 1 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 6/14/2018

VAERS ID: 344160 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 1 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 8/14/2018

VAERS ID: 344160 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 1 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 9/14/2018

VAERS ID: 344160 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 1 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.


Changed on 10/14/2018

VAERS ID: 344160 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Georgia
Vaccinated:2009-03-31
Onset:2009-03-31
Submitted:2009-04-14
Entered:2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB262A / 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0570X / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2670AA / 1 UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B029AA / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Death, Pyrexia, Streptococcal bacteraemia, Blood test abnormal, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-04-03
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? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat 4/24/09 PCP records received which reveal 11yr WCC 3/31/09 with no medical c/o. Vax given- Hep A, Gardasil, TDaP and MCV4.
Preexisting Conditions: PMH: foot swelling. Sickle-cell trait.
Allergies:
Diagnostic Lab Data: diagnostic laboratory, a group A strep in the blood was found. Labs 4/1/09: CBC with WBCs 11.1 73% segs, 13.1% lymphs, 12.6% monos. UA WNL Labs 4/3/09: CK 116. LDH 389. Na+ 131. K 3.1. Cl 94. CO2 18.6. Anion gap 21.5. Glucose 170. Albumin 3.3. Globulin 4.2. AST 132. ALT 90. Aldolase 22.3. WBCs 8.4 with 16% bands, 12% lymphs. Abnormal RBC morphology. Hgb 11.1. Hct 33.6. MCV 70.3. MCH 23.4 UA (+) for 100 Glucose, urobilinogen 8.0, (+) reducing subst. UC (+). Blood cx (+) Strep pyogenes Group A. CXR ? bronchitis or atypical pneumonia.
CDC 'Split Type': WAES0904USA01011

Write-up: Information has been received from a physician concerning an 11 year old female who on 30-MAR-2009 (last week) was vaccinated with the first dose of GARDASIL. Concomitant therapy included VAQTA, MENACTRA and DTAP (unspecified) on the same day. Patient complained about sore throat a week prior to vaccination. A week later some kind test was performed and it showed that a group A strep in the blood was found. On approximately 30-MAR-2009, after getting the first dose of GARDASIL the patient experienced fever and pain in the hip after getting the vaccine. The patient died on 03-APR-2009. The patient sought unspecified medical attention. Additional information has been requested. 4/24/09 ER record received for DOS 4/1/09 with dx: Fever. Pediatric Viral syndrome. Pt presented with L hip pain and fever. PE (+) for tenderness over L anterior thigh. Tx with analgesic and d/c. 4/24/09 ER record received for DOS 4/3/09 with dx: Post-vaccination reaction. Pt presented again to ER with fever of 102''F, body aches, inability to walk 2'' to leg pain, nausea, vomiting, rash and polymyagias. PE (+) for extremity pain and swelling, rash, as well as not sleeping and acting differently. Transferred to higher level of care. 4/24/09 MR received for DOS 4/3-4/2009 with Final DX: Necrotizing fasciitis (gram (+) cocci with septic shock). Pt expired 4/4/09. Pt admitted from local facility for eval of fever with difficulty ambulating. Neuro/ortho consults on arrival with probable dx: infectious myositis. Tx with IV abx however IV access was lost and pt became hypotensive and with eveidence of septic shock with cardiovascular instability. Pt intubated and despite extensive resuscitation efforts pt expired. 4/24/09 Autopsy report received with COD: Necrotizing Fasciitis (Gram (+)) with septic shock.

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