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This is VAERS ID 356938

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 356938 (history)  
Form: Version .0  
Age: 19.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2008-07-21
Onset:2008-09-12
   Days after vaccination:53
Submitted: 2009-09-10
   Days after onset:363
Entered: 2009-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 17400 / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arrhythmia, Biopsy heart abnormal, Bronchitis, Chest pain, Chills, Death, Dizziness, Dyspnoea, Fatigue, Feeling cold, Headache, Muscle spasms, Nausea, Oropharyngeal pain, Pain, Petechiae, Productive cough, Pulmonary congestion, Pulmonary oedema, Pyrexia, Sputum discoloured, Sternal fracture
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Oropharyngeal lesions, non-neoplastic, non-infectious and non-allergic (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-09-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0~Patient
Other Medications: Yaz until 3/17/08. Femcon beginning 3/17/08. Anaprox as needed.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None. I do have copies of all medical history from 01/08/2004 to the time of her death that I can provide if needed. The Medical Examiners office will have tissue samples until 4/2010.
CDC Split Type:

Write-up: Headache, Nausea, dizziness, chilling, tiredness, shortness of breath, complained of chest plain, severe cramps. 9/14/09 Received vaccine & PCP medical records which reveal patient seen 12/5/07 & 2/27/08 with sore throat, fever, chills, fatigue, body aches, productive cough w/yellow sputum & HA. Dx both times w/acute bronchitis & tx w/antibiotics & cough syrup. 9/25/09 Autopsy report received DOD 09/12/2008. Acute Cardiac Arrhythmia of Unknown Etiology. Addtional information abstracted: Heart with focal microscopic ischemic changes, pulmonary congestion and edema. Rare petechiae: conjunctival, periorbital and laryngeal. Resuscitation related sternal fracture.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=356938


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