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This is VAERS ID 430780

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 430780
VAERS Form:
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 2 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 10/11/2011

VAERS ID: 430780 Before After
VAERS Form:
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 0 UN LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 2 UN LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 7/7/2013

VAERS ID: 430780 Before After
VAERS Form:
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 0 LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 0 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 2 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 9/14/2017

VAERS ID: 430780 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 0 1 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 2 3 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 2/14/2018

VAERS ID: 430780 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 1 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 3 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 6/14/2018

VAERS ID: 430780 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 1 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 3 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 8/14/2018

VAERS ID: 430780 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 1 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 3 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 9/14/2018

VAERS ID: 430780 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 1 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 3 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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.


Changed on 10/14/2018

VAERS ID: 430780 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:California
Vaccinated:2011-03-28
Onset:2011-04-11
Submitted:2011-08-23
Entered:2011-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3741AA / 1 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0565Z / 3 LA / UN

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Blood culture positive, Cardiac failure, Cardiomyopathy, Death, Sudden cardiac death, Autopsy, Drug screen negative, Microscopy, Streptococcus test positive, Body fluid analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mildly overweight; concern for idiopathic scoliosis
Allergies:
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':

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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