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This is VAERS ID 743123

(NOTE: This result is from the 4/14/2018 version of the VAERS database)

Case Details

VAERS ID: 743123 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2018-02-08
Onset:2018-02-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2018-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5J594 / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. N026812 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M17013 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5563AA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Influenza, Respiratory distress, Septic shock
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2018-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: vaginal itching
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received immunizations on 2/8/18. She presented to ED on 2/11/18 in respiratory distress/ septic shock and passed away the same day, presumably from Influenza B.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180414&IDNUMBER=743123


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