This is VAERS ID 442402
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| 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 | | IM | RA | | MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) | SANOFI PASTEUR | U4006AA | | IM | RA | | TDAP: TDAP (BOOSTRIX) | GLAXOSMITHKLINE BIOLOGICALS | AC52B072EA | | IM | RA | |
| 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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Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=442402
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