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This is VAERS ID 317757

Case Details

VAERS ID: 317757 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Indiana  
   Days after vaccination:2
Submitted: 2008-06-27
   Days after onset:12
Entered: 2008-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiomegaly, Death, Passive smoking, Splenomegaly, Toxicologic test normal
SMQs:, Cardiac failure (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-06-15
   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: overweight PMH: recurrent colds/sore throat, neg strep.
Diagnostic Lab Data: toxicology and other test came back negative expect trace amount of nicotine (father heavy smoker)
CDC Split Type:

Write-up: Death -coroner says enlarged heart & enlarge spleen 7/4/08 Reviewed PCP medical records of 1999-6/2008 which included vax record. In 8/2007, c/o of tiredness & loss of appetite. Monospot (-). On day of vax, patient was well, weight noted as 237, otherwise no complaints. 7/8/08 Autopsy report states COD as arrhythmia due to cardiomyopathy.States anatomic findings of obesity, pulmonary edema, mild & left ventricular hypertrophy w/myocardial nuclear enlargement. Patient had been found non-responsive by family. EMS found patient cyanotic w/rigor & no further resuscitation was performed. Family reported patient had been well earlier in the evening. Albuterol inhaler was found at scene but no suspicious features at scene.

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