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This is VAERS ID 362855

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 362855 (history)  
Form: Version .0  
Age: 35.0  
Gender: Female  
Location: Oregon  
Vaccinated:2009-10-22
Onset:2009-10-25
   Days after vaccination:3
Submitted: 2009-10-26
   Days after onset:1
Entered: 2009-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE) / MEDIMMUNE VACCINES, INC. 500765P / 0 - / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain upper, Acidosis, Acute respiratory distress syndrome, Anisocytosis, Asplenia, Band neutrophil percentage increased, Base excess decreased, Blood bicarbonate decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood glucose decreased, Blood potassium decreased, Brain injury, Cardiac arrest, Cerebrovascular arteriovenous malformation, Chest X-ray abnormal, Chills, Cyanosis, Death, Diarrhoea, Dyspnoea, Electrocardiogram ST-T change, Electrocardiogram abnormal, Electromechanical dissociation, Endotracheal intubation, Glomerular filtration rate decreased, Gram stain positive, Granulocyte count decreased, Haematocrit decreased, Haemolytic anaemia, Histology abnormal, Hyperhidrosis, Hypotension, Infection, Influenza like illness, Influenza serology negative, Intensive care, Livedo reticularis, Lung infiltration, Lymphocyte count increased, Lymphocyte morphology abnormal, Lymphocyte percentage increased, Mean cell haemoglobin, Mean cell haemoglobin concentration, Metamyelocyte percentage increased, Nausea, Neutrophil percentage decreased, Oxygen saturation decreased, PCO2 increased, Platelet count increased, Pneumococcal sepsis, Pneumonia pneumococcal, Pulse absent, Red blood cell abnormality, Red blood cell count decreased, Red cell distribution width increased, Renal disorder, Respiratory arrest, Resuscitation, Sepsis, Septic shock, Sinus tachycardia, Splenectomy, Streptococcus identification test positive, Tachycardia, Tachypnoea, Vaginal haemorrhage, Vomiting, White blood cell count increased, White blood cell morphology abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Haemolytic disorders (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Agranulocytosis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Congenital, familial and genetic disorders (narrow), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Cerebrovascular disorders, not specified as haemorrhagic or ischaemic (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Malignant lymphomas (broad), Myelodysplastic syndrome (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: spherocytosis, hemolitic onemica
Preexisting Conditions: none. /27/09 ER and hospital records received service date 10/25/09. Splenectomy. Appendectomy. 11/02/09: Primary Care Records received for date of service 10/9/09. PMH: Heriditary spherocytosis with splenectomy, D&C, L ACL Repair, L arthroscopic knee surgery.
Allergies:
Diagnostic Lab Data: /27/09 ER and hospital records received service date 10/25/09. LABS and DIAGNOSTICS: ECG - Abnormal, sinus tachycardia, Nonspecific ST and T wave abnormality. Arterial Blood gases: pCO2 50 mmHg (H) O2 Sat 83% (L) Bicarb 8.0 mmol/L (L) Base Excess -26.0 mEq/L (L) pH 6.8 (L). CHEM - Potassium 3.0 mmol/L (L) Glucose 27 mg/dL (L) Creatinine 2.42 mg/dL (H) AST 121 IU/L (H) Bilirubin Total 1.6 mg/dL (H). GFR 28 mL/min/1.73 m2 (L). CBC - RDW 15.0% (H) PLT 91 10^9/L (L) Neutrophils 20.0% (L) Bands 20% (H) Metamyelocytes 3% (H) Lymph 55.0% (H) Lymphs Atyp 1% (H) Anisocytosis slight, Howell Jolly Body few, Vacuolated Polys moderate. Blood culture (+) for Streptococcus pneumoniae. Chest X-ray - Abnormal. 10/29/09 Hospital lab report. Blood Culture Fi
CDC Split Type:

Write-up: Patient got sick with flu like symptoms on 10/24 around 1PM, went to hospital with trouble breathing around 9PM, was pronounced deceased at 1AM on 10/25. 10/27/09 ER and hospital records received service date 10/25/09. Assessment: Death due to septic shock secondary to infection of unknown source. Asplenia. Patient had nausea, vomiting, chills, stomach cramping, diarrhea, tachypnea, hypotension, diaphoresis for one day. Limited oral intake. Became cyanotic around lips, fingernails, and toenails. Presented to ER hypotensive, hypoxic, no longer breathing. Tachycardia. Cardiac arrest presenting as pulseless electrical activity (PEA). Hyperacidemia. Resusitation. Intubated and transported to ICU. Bilateral infiltrates consistent with acute respiratory distress syndrome. End-organ damage including kidneys and brain. Repeated PEA. No pulse. Mottling of head and extremities. Overwhelming sepsis and septic shock. Patient expired. 11/02/09: Primary Care Records received for date of service 10/9/09. Seasonal flu vaccine record received VAERS updated. Assessment: Presented with vaginal bleeding x 3 weeks, had hx. of D&C in 08 2/2 heavy vaginal bleeding. Also presented with a cold that started 5 days prior, afebrile at visit. Seasonal Flu vaccine given. 11/05/09 Diagnostic/lab results received. IDPB Test results: Lung section shows increased interstitial inflammatory infiltrates. Heart section shows focal interstitial edema and extravasation. No evidence of myocarditis. Liver section shows increased portal infiltrates and dilated sinusoids with Kupffer cell hyperplasia. Special stains: Scattered gram-positive cocci in lung, heart and liver. Immunohistochemical Assays: (+) Strep penumoniae in lung, heart and liver. (-) for influenza virus. PCR Assays: Negative for 2009 pandemic H1N1 influenza A virus. PCR for penumoniae pending. 12/14/09 Autopsy Records receivedI. DOD 10/25/09. Final Cause of Death: Streptococcus Pneumonia Sepsis. II. Hemolytic Anemia with Splenectomy. Additional information abstracted: Arteriovenous malformation of brain. Cholecystectomy remote. Blood cultures (+) for streptococcus pneumonias.


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