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This is VAERS ID 526687

Case Details

VAERS ID: 526687 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2014-03-07
Onset:2014-03-19
   Days after vaccination:12
Submitted: 2014-03-25
   Days after onset:6
Entered: 2014-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006857 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR WV04003A / 1 UN / -

Administered by: Military       Purchased by: Military
Symptoms: Cardiomegaly, Histology abnormal, Myocarditis, Sudden death, Toxicologic test
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Cardiomegally with four chamber dilation of the heart. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.
CDC Split Type:

Write-up: Sudden death. Cardiomegally with four chamber dilation. Histologic diagnosis of myocarditis. At the time of this report toxicology is still pending.


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