This is VAERS ID 430780
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| VAERS ID: | 430780 (history) | Vaccinated: | 2011-03-28 | | Age: | 14.0 | Onset: | 2011-04-11, Days after vaccination: 14 | | Gender: | Female | Submitted: | 2011-08-23, Days after onset: 134 | | Location: | California | Entered: | 2011-08-23 | |
| Life Threatening? No |
Died? Yes
Date died: 2011-04-11
Days after onset: 0 |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis | | Diagnostic Lab Data: Autopsy, including microscopy slides. Heart blood culture showed alpha streptococcus (not Strep. pneumoniae, not enterococcus sp., not Strep. bovis). Femoral blood and vitreous humor samples showed no drugs on complete drug screen. Vitreous panel (Glucose - 32 mg/dL, Sodium - 137 mmol/L, Potassium - 15.2 mmol/L, Chloride - 124 mmol/L, Urea Nitrogen 13 mg/dL and Creatinine - 1.3 mg/dL) | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (FLUZONE) | SANOFI PASTEUR | U3741AA | 0 | UN | LA | | HPV4: HPV (GARDASIL) | MERCK & CO. INC. | 0565Z | 2 | UN | LA | |
| Administered by: Public Purchased by: Public | Symptoms: Arrhythmia,
Autopsy,
Blood culture positive,
Body fluid analysis,
Cardiac failure,
Cardiomyopathy,
Death,
Drug screen negative,
Microscopy,
Streptococcus test positive,
Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow)
| | Write-up: Found dead in bed in a.m. by family. Pathologist stated cause of death as consistent with cardiac insufficiency, due to cardiac arrhythmia, due to probable early cardiomyopathy. Child Death Review Team felt this death was consistent with a diagnosis of sudden cardiac death. |
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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=430780
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