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This is VAERS ID 485757

(NOTE: This result is from the 9/17/2013 version of the VAERS database)

Case Details

VAERS ID: 485757 (history)  
Form: Version .0  
Age: 11.0  
Sex: Female  
Location: New York  
Vaccinated:2013-02-19
Onset:2013-02-19
   Days after vaccination:0
Submitted: 2013-02-25
   Days after onset:6
Entered: 2013-02-28
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB677CA / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H016238 / - UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U42927 / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4431BA / - UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Areflexia, Aspartate aminotransferase increased, Atelectasis, Blood alkaline phosphatase increased, Blood bilirubin decreased, Blood calcium decreased, Blood chloride decreased, Blood gases abnormal, Blood glucose increased, Blood magnesium decreased, Blood phosphorus decreased, Blood potassium decreased, Brain death, Brain injury, Carbon dioxide decreased, Cardiac arrest, Chest X-ray abnormal, Computerised tomogram abnormal, Computerised tomogram head, Crying, Culture urine positive, Cyanosis, Death, Diabetes insipidus, Drug screen positive, Electroencephalogram abnormal, Endotracheal intubation, Epilepsy, Escherichia test positive, Glucose urine present, Gram stain positive, Mechanical ventilation, Mydriasis, Nitrite urine present, Pleural effusion, Protein urine present, Pupil fixed, Pyrexia, Red blood cells urine positive, Respiratory arrest, Resuscitation, Skin discolouration, Sputum culture positive, Tremor, Unresponsive to stimuli, Urine ketone body present, Urine leukocyte esterase positive, White blood cells urine positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Parkinson-like events (broad), Drug abuse and dependence (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-02-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DILANTIN; Phenobarb
Current Illness: Medical record - cough - resp sym x 5 days (doc denies) The following information was obtained through follow-up and/or provided by the government. 8/26/13: Viral URI.
Preexisting Conditions: Microcephaly; seizure The following information was obtained through follow-up and/or provided by the government. 4/15/30 PMH: Congenital hydrocephalus with VP shunt. GDD and g-tube dependent. Global Developmental Delay. Seizure disorder.
Allergies:
Diagnostic Lab Data: See reverse The following information was obtained through follow-up and/or provided by the government. 8/26/13 Representative Labs and Diagnostics: CHEM - Potassium 3.4 mmol/l (L) Chloride 116 mmol/l (H) CO2 15 mmol/l (L) Glucose 460 mg/dl (H) Calcium Total 6.8 mg/dl (L) Phosphorus 1.1 mg/dl (L) Magnesium 1.3 mg/dl (L) Bilirubin 0.1 mg/dl (L) Alk Phos 409 U/L (H) AST 556 U/L (H) ALT 342 U/L (H). Abnormal Arterial Blood Gases. Urinalysis - Glucose 1000, Ketone trace, Blood moderate, Protein 300, Nitrite (+), Leuk Est small, RBC 5-10 /hpf, WBC 5-10 /hpf. Drug Screen Urine - Barbiturates (+). Urine Culture (+) for E coli. Sputum Gram Stain (+) for several organisms, normal flora. Chest X-ray - Abnormal, atelectasis, pleural effusion. CT Head
CDC Split Type:

Write-up: 2/19/13 23:24 Pt brought in by ambulance in cardiac arrest, "mother states pt has been having cough & URI symptoms since 5 days - seen by doctor 2/19/13 & given 4 vaccines. Pt sleeping & crying - suddenly pt turned white & was not breathing - 911 called & intubated. Doctor states he was not aware of any illness & child''s DILANTIN level was 1.0. No lab found in medical record child revived & transfer to another hospital where child died on 2/20/13. The following information was obtained through follow-up and/or provided by the government. 8/19/13 Death Certificate received. Final Cause of Death: Anoxic brain death, due to Epilepsy (non traumatic), due to congenital hydrocephalus. 8/26/13 Hospital records and discharge summary received. Service date 2/20/13. Diagnosis: Brainstem death. Patient presents in cardiac arrest. Earlier relative noted head shaking and perioral cyanosis; no respiratory effort seen by EMS, asystole. CPR, intubated, at ED spontaneous sinus rhythm obtained and postresusitation care initiated. Transfered to hygher level facility and placed on mechanical ventilator. Fever. Developed diabetes insipidus, vasopressin drip initiated. Unresponsive, pupils fixed and dilated, no reflexes illicited. No cortical or brainstem activity, brainstem death declared. 4/15/30 Discharge summary received. No information abstracted.


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