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This is VAERS ID 417137

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 417137 (history)  
Form: Version .0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2011-01-04
Onset:2011-02-02
   Days after vaccination:29
Submitted: 2011-02-08
   Days after onset:6
Entered: 2011-02-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0096Z / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3432AA / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Blood culture positive, CSF culture positive, Culture throat positive, Death, Dehydration, Diarrhoea, Disseminated intravascular coagulation, Excoriation, Nausea, Obesity, Oropharyngeal pain, Pleural effusion, Pulmonary haemorrhage, Streptococcal bacteraemia, Streptococcus test positive, Toxic shock syndrome
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Toxic-septic shock conditions (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-02
   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:
Current Illness: none
Preexisting Conditions: Hay fever; Animal fur
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN1101

Write-up: Patient deceased within 30 days of vaccine administration.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20140614&IDNUMBER=417137


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