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This is VAERS ID 494024

History of Changes from the VAERS Wayback Machine

First Appeared on 6/12/2013

VAERS ID: 494024
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 8/12/2013

VAERS ID: 494024 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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 Yes, days: (blank) 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 9/17/2013

VAERS ID: 494024 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Acute myeloid leukaemia, Aspartate aminotransferase increased, Bilirubin conjugated increased, Blood albumin decreased, Blood bilirubin increased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen decreased, Blood gases abnormal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Cardiac arrest, Cerebral haemorrhage, Chest X-ray abnormal, Coma, Corneal reflex decreased, Death, Depressed level of consciousness, Disseminated intravascular coagulation, Ecchymosis, Glomerular filtration rate decreased, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Haptoglobin increased, HIV test negative, Hypertonia, Injection site bruising, Intensive care, International normalised ratio increased, Leukaemia, Malaise, Mean cell haemoglobin concentration increased, Mucosal dryness, Mydriasis, Nausea, Oedema peripheral, Pallor, Petechiae, Platelet count decreased, Platelet transfusion, Posturing, Protein total decreased, Prothrombin time prolonged, Purpura, Pyrexia, Red blood cell count decreased, Renal failure acute, Respiratory failure, Resuscitation, Sepsis, Thrombocytopenia, Unresponsive to stimuli, Upper respiratory tract infection, White blood cell count increased, Mental status changes, Contusion, Promyelocyte count increased, Neutrophil percentage decreased, Myelocyte percentage increased, Lymphocyte percentage decreased, Central venous catheterisation, Red cell distribution width increased, Mean platelet volume increased, Band neutrophil percentage increased, Blood smear test abnormal, Blast cell count increased, Metamyelocyte percentage increased, Breath sounds abnormal, Transfusion, Fluorescent in situ hybridisation, Mechanical ventilation, Endotracheal intubation, Oropharyngeal pain, Legionella test, Staphylococcus test negative, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known The following information was obtained through follow-up and/or provided by the government. PMH: back strain Dec 2011. Occasional marijuana use.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 6/17 & 27/2013 lab/diagnostic records received for DOS 2/7-10/2012. Blood: WBC 41.9 K/uL (H), segs 5% (L), bands 3% (H), lymphs 14% (L), metamyelocytes 13% (H), myelocyte 13% (H), promyelocyte 14% (H), blast 41% (H), Plt 12 K/uL (L), MPV 10.8 K/uL (H), RBC 2.63 M/uL (L), Hgb 7.7 g/dL (L), Hct 22.6% (L), MCHC 36.2 g/dL (H), RDW 15.4% (H), Na 159 mmol/L (H), Cl 118 mmol/L (H), Mg 2.4 mg/dL (H), glucose 255 mg/dL (H), BUN 42 mg/dL (H), creatinine 3.8 mg/dL (H), GFR 22 (L), protein 6.3 g/dL (L), albumin 2.6 g/dL (L), PT 18.8 sec (H), INR 1.63 (H), fibrinogen 165 mg/dL (L), bili total 2.6 mg/dL (H), direct bili 0.33 mg/dL (H), AST 130 U/L (H), LDH 851 U
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012. The following information was obtained through follow-up and/or provided by the government. 6/17/2013 hospital records received for DOS 2/7-10/2012. D/c Dx''s: 1) acute myeloblastic leukemia; 2) intracerebral hemorrhage; 3) cerebral coma; 4) acute kidney injury. Pt to outside facility w/ 2 wk hx URI & easy bruising. Progressed to sore throat, fever, feeling unwell, nausea, vomiting, then altered mentation. Intubated for suspected acute respiratory failure thought to be 2^ to meningococemia. Pt transferred in critical condition w/ severe thrombocytopenia, petechia, purpura, sepsis, DIC. Arrival PE: intubated, central line, obtunded, occasional extensor posturing, hypertonicity, LE edema, pupils dilated, poor corneal reflexes, unresponsive to painful stimuli, pallor, dry oropharygeal mucosa, vesicular breath sounds in all regions, ecchymotic areas to LE & abdomen. Admitted to ICU. Tx''t: mannitol, hyperventilation, Plt & RBC transfusions. Evidence of acute myeloblastic leukemia, large intracerebral hemorrhage 2^ to severe thrombocytopenia, minimal brainstem function. Developed cardiac arrest, unable to resuscitate, pronounced dead.


Changed on 3/14/2015

VAERS ID: 494024 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Acute myeloid leukaemia, Aspartate aminotransferase increased, Bilirubin conjugated increased, Blood albumin decreased, Blood bilirubin increased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen decreased, Blood gases abnormal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Cardiac arrest, Cerebral haemorrhage, Chest X-ray abnormal, Coma, Corneal reflex decreased, Death, Depressed level of consciousness, Disseminated intravascular coagulation, Ecchymosis, Glomerular filtration rate decreased, Haematemesis, Haematocrit decreased, Haemoglobin decreased, Haptoglobin increased, HIV test negative, Hypertonia, Injection site bruising, Intensive care, International normalised ratio increased, Leukaemia, Malaise, Mean cell haemoglobin concentration increased, Mucosal dryness, Mydriasis, Nausea, Oedema peripheral, Pallor, Petechiae, Platelet count decreased, Platelet transfusion, Posturing, Protein total decreased, Prothrombin time prolonged, Purpura, Pyrexia, Red blood cell count decreased, Renal failure acute, Respiratory failure, Resuscitation, Sepsis, Thrombocytopenia, Unresponsive to stimuli, Upper respiratory tract infection, White blood cell count increased, Mental status changes, Contusion, Promyelocyte count increased, Neutrophil percentage decreased, Myelocyte percentage increased, Lymphocyte percentage decreased, Central venous catheterisation, Red cell distribution width increased, Mean platelet volume increased, Band neutrophil percentage increased, Blood smear test abnormal, Blast cell count increased, Metamyelocyte percentage increased, Breath sounds abnormal, Transfusion, Fluorescent in situ hybridisation, Mechanical ventilation, Endotracheal intubation, Oropharyngeal pain, Legionella test, Staphylococcus test negative, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known The following information was obtained through follow-up and/or provided by the government. PMH: back strain Dec 2011. Occasional marijuana use.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 6/17 & 27/2013 lab/diagnostic records received for DOS 2/7-10/2012. Blood: WBC 41.9 K/uL (H), segs 5% (L), bands 3% (H), lymphs 14% (L), metamyelocytes 13% (H), myelocyte 13% (H), promyelocyte 14% (H), blast 41% (H), Plt 12 K/uL (L), MPV 10.8 K/uL (H), RBC 2.63 M/uL (L), Hgb 7.7 g/dL (L), Hct 22.6% (L), MCHC 36.2 g/dL (H), RDW 15.4% (H), Na 159 mmol/L (H), Cl 118 mmol/L (H), Mg 2.4 mg/dL (H), glucose 255 mg/dL (H), BUN 42 mg/dL (H), creatinine 3.8 mg/dL (H), GFR 22 (L), protein 6.3 g/dL (L), albumin 2.6 g/dL (L), PT 18.8 sec (H), INR 1.63 (H), fibrinogen 165 mg/dL (L), bili total 2.6 mg/dL (H), direct bili 0.33 mg/dL (H), AST 130 U/L (H), LDH 851 U
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012. The following information was obtained through follow-up and/or provided by the government. 6/17/2013 hospital records received for DOS 2/7-10/2012. D/c Dx''s: 1) acute myeloblastic leukemia; 2) intracerebral hemorrhage; 3) cerebral coma; 4) acute kidney injury. Pt to outside facility w/ 2 wk hx URI & easy bruising. Progressed to sore throat, fever, feeling unwell, nausea, vomiting, then altered mentation. Intubated for suspected acute respiratory failure thought to be 2^ to meningococemia. Pt transferred in critical condition w/ severe thrombocytopenia, petechia, purpura, sepsis, DIC. Arrival PE: intubated, central line, obtunded, occasional extensor posturing, hypertonicity, LE edema, pupils dilated, poor corneal reflexes, unresponsive to painful stimuli, pallor, dry oropharygeal mucosa, vesicular breath sounds in all regions, ecchymotic areas to LE & abdomen. Admitted to ICU. Tx''t: mannitol, hyperventilation, Plt & RBC transfusions. Evidence of acute myeloblastic leukemia, large intracerebral hemorrhage 2^ to severe thrombocytopenia, minimal brainstem function. Developed cardiac arrest, unable to resuscitate, pronounced dead.


Changed on 9/14/2017

VAERS ID: 494024 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 1 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 2/14/2018

VAERS ID: 494024 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 6/14/2018

VAERS ID: 494024 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 8/14/2018

VAERS ID: 494024 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 9/14/2018

VAERS ID: 494024 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


Changed on 10/14/2018

VAERS ID: 494024 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2012-01-25
Onset:2012-01-25
Submitted:2013-06-12
Entered:2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Pyrexia, Unresponsive to stimuli, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-02-10
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.

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