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This is VAERS ID 442402

Case Details

VAERS ID:442402 (history)  Vaccinated:2011-10-17
Age:15.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-11-14, Days after onset: 28
Location:Oregon  Entered:2011-11-14
Life Threatening? No
Died? Yes
   Date died: 2011-10-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, Lyrica, Diazapam, Adderall
Current Illness: No
Preexisting Conditions: Seizure Disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1262AA IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4006AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B072EA IMRA
Administered by: Private     Purchased by: Public
Symptoms: Death, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial soreness and swelling. Death 10/20/2011.

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