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From the 9/17/2021 release of VAERS data:

Found 3,093 cases where Patient Died and Vaccination Date from '2007-08-01' to '2020-11-30'



Case Details

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VAERS ID: 304418 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2007-11-28
Onset:2007-11-28
   Days after vaccination:0
Submitted: 2008-01-30
   Days after onset:63
Entered: 2008-02-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR AFLUA316AA / UNK LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Death, Intensive care, Malaise, Mechanical ventilation
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2008-01-17
   Days after onset: 50
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Many PMH: depression & anxiety, under psychiatric care. Type 2 DM; recurrent UTIs; hyperlipidemia; LBP w/multiple surgeries; thyroid disease; obesity; memory loss. Hx of pneumonia. Secondhand smoke exposure. Family hx of DM & cardiac disease. Allergy: Multiple meds including PCN, sulfa & vancomycin.
Allergies:
Diagnostic Lab Data: LABS: Admit CBC w/WBC 7/9 (N), H/H 11.2/32.7 (L), neutros 82.1% (H), lymphs 6.9% (L), eos 6.7 (H). Admit Chem: Na 134 (L)CT chest scan revealed bilateral nodular lung inflitrates. CT chest angio r/o pulmonary emboli. Bronchoscopy revealed hemorrhagic secretions. Transbronchial biopsy. Lung biopsy via thoracotomy revealed interstitial pneumonitis. FANA (+) w/titer speckled pattern 1:160 (H). Neut cyto aby IgG <1:20 (H). EKG abnormal. Echocardiogram abnormal w/RV dilation & dysfunction.
CDC Split Type:

Write-up: She was immediately sick. Very sick for 4 more days. Kept getting worse. Dec 20 put in hospital. Dec 25 to ICU. Dec 27 respirator. Died 1/17/08. 2/21/08 Reviewed hospital medical records which included clinic visit & vax record of 11/28/07. Database updated. Patient w/palpitations intermittently when anxious or blood sugar low, 10# wt loss over past several months since the death of parent. H&P indicates patient experienced sinusitis, fever, chills, sore throat, nasal congestion, postnasal drip, swollen cervical lymph nodes & productive cough x 3 wks. Dx w/bronchitis & pneumonia & tx w/oral antibiotics as outpatient w/o increasing fever, SOB & weakness. Admitted 12/20/07-01/17/2008 w/community acquired pneumonia & dehydration. Consults by pulmonogy, surgery & ID. Conditioned worsened & was intubated & transferred to ICU. Developed pneumothorax s/p transbronchial biopsy & had chest tube placed. Developed acute ARDS & was trached 1/8/08. Continued to deteriorate & expired 1/17/2008. FINAL DX: none provided on D/C summary. No autopsy done per med records. Death certificate requested from funeral home. 2/21/08 Reviewed death certificate which states COD as respiratory failure with pneumonia as underlying cause.


VAERS ID: 304505 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: North Carolina  
Vaccinated:2008-01-29
Onset:2008-01-30
   Days after vaccination:1
Submitted: 2008-01-31
   Days after onset:1
Entered: 2008-02-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0260U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013D / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-31
   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: NONE
Current Illness: NONE
Preexisting Conditions: Hypospadias; Benign tumors; Strawberry hemangioma PMH: umbilical hernia
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, Death 2/12/08 Received vax record from reporter/provider & confirms as reported. 4/11/08Reviewed autopsy report which states COD as SIDS. Autopsy also states patient was 32 wk preemie & developed fever 104 next day tx w/antipyretic & seen in ER. Patient found cold, breathing arrested & unresponsive on 1/31/08 while co-sleeping w/parents. EMS coded & taken to ER in cardiopulomonary arrest where resuscitation unsuccessful. Accidental overlay could not be completely ruled out.


VAERS ID: 304711 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2008-01-25
Onset:2008-01-25
   Days after vaccination:0
Submitted: 2008-02-01
   Days after onset:7
Entered: 2008-02-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2514AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pain, Speech disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-26
   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: Hormones; High BP Pills
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA080203

Write-up: 01/25/08 11:00 PM Couldn''t breathe or talk at fist. Then c/o pain in chest - then all over. 11:06 Ambulance called. 11:35 Ambulance arrived. Transported to hospital. 09/08 Had problems with SOB to ER - "Test did not show anything" (info given by daughter). 2/12 /08-myocardial infarction per coroner''s office. no autopsy performed. 4/7/08-ER records received for DOS 1/26/08-cardiac arrest. Prounced 0054.


VAERS ID: 304745 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Michigan  
Vaccinated:2008-01-25
Onset:2008-01-28
   Days after vaccination:3
Submitted: 2008-01-28
   Days after onset:0
Entered: 2008-02-12
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292A / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35169 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-28
   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: Bronchiolitis
Preexisting Conditions: PMH: recent RSV infection.
Allergies:
Diagnostic Lab Data: 3/19/08 Autopsy report states microscopic exam of lung tissue revealed interstitial mononuclear inflammatory infiltrates & occasional multi-nucleated giant cells c/w pneumonia of viral etiology.
CDC Split Type:

Write-up: Unexplained death - under investigation. 3/19/08 Autopsy report states microscopic exam of lung tissue revealed interstitial mononuclear inflammatory infiltrates & occasional multi-nucleated giant cells c/w pneumonia of viral etiology.


VAERS ID: 304951 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Female  
Location: Louisiana  
Vaccinated:2008-02-13
Onset:2008-02-14
   Days after vaccination:1
Submitted: 2008-02-14
   Days after onset:0
Entered: 2008-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF071AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B701458 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acoustic stimulation tests, Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-14
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE. CHILD WAS BORN AT 29 WEEKS BY C-SECTION. MOM HAD GESTATIONAL DIABETES, SMOKED DURING PREGNANCY AND TOOK PHENOBARBITAL IN MAY 2007
Allergies:
Diagnostic Lab Data: HEARING AND VISION SCREENING DONE ON SAME DAY. NO LABS.
CDC Split Type:

Write-up: NO ADVERSE REACTIONS AT TIME OF VACCINATION. CHILD WAS EXAMINED BY PHYSICIAN AND DEEMED HEALTHY. CHILD WENT HOME ALERT AND SHOWING NO NEGATIVE SYMPTOMS BUT WE WERE ADVISED BY CORONER''S OFFICE ON FEBRUARY 14, 2008 THAT BABY DIED. CORONER''S OFFICE DOES NOT KNOW CAUSE OF DEATH -- POSSIBLE SIDS. 2/19/08 Reviewed provisional autopsy which states COD as SIDS. Patient co-sleeping w/parents & unresponsive when parent awoke. Both parents smoke in home. Mother w/gestational diabetes. Home unkept & narcotics found in home. 3/13/08 Reviewed autopsy report which is unchanged from prelim autopsy.


VAERS ID: 305043 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Colorado  
Vaccinated:2007-11-16
Onset:2007-11-21
   Days after vaccination:5
Submitted: 2008-02-13
   Days after onset:84
Entered: 2008-02-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2454AA / 3 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Aphasia, Confusional state, Death, Demyelination, Disorientation, Headache, Memory impairment, Muscular weakness, Myalgia, Mydriasis, Pupil fixed, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-11-28
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None at the time of vaccination
Current Illness: Had pneumonia 2 weeks prior and then had a viral illness one week prior.
Preexisting Conditions: Hypertension, dermatitis, pre-diabetes; Allergic to codeine, sulfa, neosporin, and penicillin Capillaritis, post inflammatory hyperpigmentation of LEs, sinusitis, constipation, impaired glucose metabolism. Allergies: congestac, Vioxx, ASA, codeine, bactrim, neosprin.
Allergies:
Diagnostic Lab Data: LABS: CT of head & MRI of brain c/w ADEM. CSF WBCs 789(H), polys 89%. Repeat CT scan revealed worsening demyelination. Blood & CSF c/s neg. Brain biopsy revealed ADEM. WBC 15,500. CT abdomen/pelvis revealed fatty liver & gallbladder distension, both mild. CXR WNL.
CDC Split Type:

Write-up: On 11/21 the husband noticed that patient was having confusion and forgetting little things. The husband notified the PCP who advised him to take the patient to the hospital. Prior to this the patient was treated on 10/24/07 for pneumonia with 7 days of Avelox. On 11/5 the patient came to the clinic complaining of myalgias. This was ruled to be a viral process. On 11/16 the patient recieved the influenza vaccine in the clinic. The morning of 11/21 the patient woke up with a headache and progressively became disoriented with muscle weakness and by 4pm that day could not talk. Once at the hospital the patient was given steroids, antibiotics, and antifungals. The patient improved for two days and then got progressively worse each day after that. The patient became completely unresponsive, pupils fixed and dilated by 11/28. Patient expired on 11/28. Diagnosis was unclear. Patient with definite demylinating process and encephalopathy, so vaccine reaction was in the differential. However some of the symptoms did start prior to receiving the vaccine. 8/26/08 Death certificate states COD as acute disseminated encephalomyelitis. 2/19/08 Reviewed hospital medical records of 11/21-11/28/2007. FINAL DX: acute disseminated encephalomyelitis; hyperlipidemia; pre-diabetes; & HTN. Records reveal patient experienced confusion, disorientation & loss of speech x 1 day Admitted 11/21-11/28/2007 when she expired. Exam revealed inability to speak but was able to mime; cranial nerve exam WNL, general muscle weakness w/reflexes intact. Tx w/antibiotics, steroids, antivirals & prophylactic antiseizure meds. Received IVIG x 2. By hospital day #4, conditioned worsened & was unresponsive w/left side weakness. C/S neg & antibiotics/antivirals were d/c. Continued to deteriorate & on vent. Family decision to withdraw tx as condition contined to worsen & pt expired. 5/2/08 Reviewed pcp medical records which included vax record that confirms as reported. Office note of 11/16/07 was for flu shot only, no pcp note. 10/24 vs for URI s/s x approx 1 week. Runny nose, facial tenderness, lightheadedness, cough, LBP, poor appetite. Apouse had been ill w/viral syndrome. CXR that day revealed patchy RUL infiltrate; CBC WNL. 10/29 visit reveals patient seen in f/u for pneumonia, dermatitis & pain in left shoulder. She had less cough & improved appetite but was still tired. CXR that day revealed near resolution of pneumonia. Records also included some hospital medical records. Neurosurgery & neurology consults done. Patient w/fever on admission.


VAERS ID: 305082 (history)  
Form: Version 1.0  
Age: 0.27  
Sex: Male  
Location: Georgia  
Vaccinated:2008-02-14
Onset:0000-00-00
Submitted: 2008-02-18
Entered: 2008-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-18
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: 11/07 - Heart Murmur heard Birth HX: c-section, no complications.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was reported dead to us by mom this morning. She stated death was around 4:00 am. 5/9/08 Autopsy report states COD as sudden unexplained death in infancy. Autopsy report also states patient was found in prone sleeping position on soft bedding w/soft pillow partially covering mouth/nose. Had been placed in bassinet on back on a soft pillow. Patient was large for his age weighing 19.6 lbs. Patient had seen PCP approx 11-12 days prior for ear infection & had finished his antibiotibcs. No problems noted on day of vaccination or afterward. PCP had noted that patient was overweight & parents counseled to reduce feeding.


VAERS ID: 305097 (history)  
Form: Version 1.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2008-01-28
Onset:2008-02-02
   Days after vaccination:5
Submitted: 2008-02-15
   Days after onset:13
Entered: 2008-02-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MU: MUMPS (MUMPSVAX II) / MERCK & CO. INC. 1982U / UNK RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Cellulitis, Cough, Death, Dizziness, Headache, Injection site pain, Injection site swelling, Nausea, Oedema peripheral, Pyrexia, Respiratory failure, Septic shock, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2008-02-08
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: [therapy unspecified]; TYLENOL; VICODIN; ROCEPHIN; NALOXONE
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Tissue exam lungs (+) for abscess formation, tissue destruction, necrosis and marked acute inflammation as well as adjacent lung tissue with acute inflammation and accumulation of proteinaceous material in alveolar spaces and marked congestion. Skin tissue exam of RUE (+) for edema, hemorrhage in subq fat and inflammation. Bacterial clusters in deep dermis and subq tissue.
CDC Split Type: WAES0802USA02238

Write-up: Information has been received from a pharmacist and a pharmacy tech concerning a 50-year-old female patient with no pertinent medical history, allergies or previous drug reactions, who on 28-JAN-2008 was vaccinated in the right upper arm with a dose of Mumpsvax II (659616/1982U) (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3). Concomitant therapy included TYLENOL, ROCEPHIN, VICODIN, NALOXONE and "afzavelrd". On 02-FEB-2008 the patient experienced nausea, vomiting, headache, light headedness, fever and cough which lasted 4-5 days. On 06-FEB-2008 the patient developed swelling and pain of the right upper extremity at the injection site, and the left lower extremity was swollen. On 08-Feb-2008, the patient was admitted to the hospital with a diagnosis of cellulitis and vomiting. She developed respiratory failure, and became septic, likely due to necrotising and vomiting. She expired after shock and cardiac arrest on 08-Feb-2008. The cause of death was fasciitis. During the hospital stay, the patient was treated with "promethezone", "NS" and "zolprclam". The adverse events were classified as type A (pharmacological) reaction. Naranjo''s Algorithm for Determination of Probability was used to assess the adverse drug reaction, and scored a 2 which indicated that they were a possible reaction to the Mumpsvax II (Jeryl Lynn). The adverse event appeared after administration of the vaccine. The vaccine was not detected in the blood or other fluids in concentrations known to be toxic. It was not known if the patient had a similar reaction to Mumpsvax II (Jeryl Lynn) or similar vaccines. According to Schumocks Criteria for Preventability, it was not considered preventable. The Mumpsvax II (Jeryl Lynn) was not inappropriate for the patient''s condition. The dose, route, and frequency of administration was not inappropriate for the patient''s age, weight, or disease state. There was no required therapeutic drug monitoring necessary or lab tests required. There was no reported drug interaction. A toxic serum of the drug concentration was not documented and there was no poor compliance involved. No product quality complaint was involved. The reporter considered the adverse events to be an other important medical event and life threatening. A lot check has been initiated. Additional information has been requested. 02/25/2008 Autopsy Report received with the following findings: 1) Abscess, Left Upper Lobe of Lung. 2) Apparent Cellulitis, Right Upper Extremity. 3) Congestion and Edema, bilateral Lungs. 4) Pleural Effusion, Left side. 5) Congestion, Liver. 6) Mild Coronary Artery Atherosclerosis. 7) Mild Atherosclerosis, Aorta. 2/27/2008 Tag2 received. 4/21/08 Initial report received from coroner. The deceased developed a high fever x 4 days s/p mumps vax for which pt did not seek treatment. On 2/8/08 pt developed severe pain in arm and leg, and began spitting up blood and was brought to the ER. Pt was admitted to the ICU at 930 am. At 1512 pt went into cardiac arrest and was prounounced dead after CPR was unsuccessful. Attending MD stated victim most likely died of sepsis or severe infection. 07/08/2008 Remainder of Autopsy report received. Final COD Abscess, Left Upper Lobe of Lung (Days). Other significant conditions: Mild Subcutaneous inflammation, skin of Right upper extremity.


VAERS ID: 305606 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2008-02-20
Onset:2008-02-22
   Days after vaccination:2
Submitted: 2008-02-25
   Days after onset:3
Entered: 2008-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1968U / 3 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-22
   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: Yasmin daily birth control
Current Illness:
Preexisting Conditions: No known drug allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden unattended death. Autopsy results pending (inconclusive 2/25/08). 2/26/08 Reviewed pcp medical records & vax records which reveal patient received HPV#1 0469U 7/16/07 & HPV#2 09300 9/17/07. In 11/20/07, noted to have left sided head pain intermittently along with lightheadedness; dx w/tension HA. HPV#3 was scheduled for 1/16/2008 but postponed due to no parental signature. Returned to office 1/24/08 for left wrist pain from cheerleading injury s/p ER vs for same on 1/19/08. Patient last seen in office by nurse only on 2/20 for HPV #3, no notes for visit. PMH: kicked in face by horse in past (undated) & had contusion on cheek; acne vulgaris, started Yasmin & topicals 4/07 w/improvement after multiple other drug failures; 1/19/08 wrist contusion from cheerleading. 5/2/08 Autopsy report states COD as undetermined. Autopsy states patient had intermittent HAs x 2 mo & had been on BCP x 1 year for acne. Found w/small facial laceration from striking flower pot when fell. The autopsy was neg for all findings. Scene indicated sudden death from collapse & fall. Suspected long QT interval syndrome w/fatal arrhythmia rather than new onset seizure in patient w/no history of either. Suggested testing family members.


VAERS ID: 305832 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Idaho  
Vaccinated:2008-01-17
Onset:2008-01-18
   Days after vaccination:1
Submitted: 2008-01-23
   Days after onset:5
Entered: 2008-02-27
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-18
   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: Synagis; Caffeine
Current Illness: No
Preexisting Conditions: Premi 32wks / H/O Apnea 3/28/08-autopsy report received-3/28/08-autopsy report received-comment:born premature at estimate 32 weeks gestation. Dichorionic twin, had some respiratory problems at birth requiring hospitalization and intubation. Left epididymis cyst.
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID08007

Write-up: Pt died within 24 hours of immunizations 3/28/08-autopsy report received cause of death:sudden unexpected infant death. 3/28/08-autopsy report received-COD: Sudden unexpected infant death.


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