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This is VAERS ID 160423

Case Details

VAERS ID: 160423 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Male  
Location: Alaska  
Vaccinated:2000-02-17
Onset:2000-03-08
   Days after vaccination:20
Submitted: 2000-03-17
   Days after onset:9
Entered: 2000-10-11
   Days after submission:207
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-08
   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: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


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