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From the 10/8/2021 release of VAERS data:

This is VAERS ID 378500

Case Details

VAERS ID: 378500 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:1
Submitted: 2010-01-27
   Days after onset:104
Entered: 2010-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Death, General physical health deterioration, Headache, Impaired work ability, Loss of consciousness, Malaise, Pain in extremity, Pyrexia, Respiratory failure, Snake bite
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-11-02
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Joint pain
Diagnostic Lab Data: UNK
CDC Split Type: B0628298A

Write-up: This case was reported by a physician and described the occurrence of respiratory failure in a 15-year-old female subject who was vaccinated with CERVARIX (GlaxoSmithKline). The subject''s medical history included joints pain. Previous and/or concurrent vaccination included CERVARIX ;GlaxoSmithKline;intramuscular;unknown deltoid given on 9 September 2009. On 14 October 2009, the subject received 2nd dose of CERVARIX (intramuscular, unknown deltoid). The subject was put under observation during 30 minutes after both vaccinations. No adverse event had occurred. On 15 October 2009, 1 day after vaccination with CERVARIX, the subject experienced a low grade fever and headache. She visited an homeopathy center where she was prescribed treatment with paracetamol, Liv 52 and RANTAC. The subject was advised to come back to the center for follow-up after 2 days of treatment. The events resolved and the subject restarted her daily chores. On 1st November 2009, the subject informed her parents that an insect has bitten her during the field work. She was not feeling well and complained about leg pain. Post noon, the subject didn''t go to work and rested at home. Overnight, her condition deteriorated. On the morning of the 2nd November 2009, an ambulance was called. The subject''s vital signs recorded at the time of shifting were poor. On the way to hospital, she became unconscious and her vital signs were not recordable. The cardio pulmonary resuscitation provided was unsuccessful. At hospital, she was declared dead due to a respiratory failure. Autopsy was rejected by the family. The physician considered the events were unrelated to vaccination with CERVARIX and so, no follow-up was necessary. The subject died on 2 November 2009 from a suspected snake bite. An autopsy was not performed.

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